| Arthrocentesis (outpatient) | $907 | N/A | $907 |
| Bacterial Culture - Aerobic Isolates | $27 | N/A | $27 |
| Bacterial Culture - Swab | $29 | N/A | $29 |
| Biopsy - Breast | $3,522 | N/A | $3,522 |
| Biopsy - Endometrial (Uterus) | $870 | N/A | $870 |
| Biopsy - Punch Biopsy of Skin | $1,161 | N/A | $1,161 |
| Blood Test - Basic Metabolic Panel | $29 | N/A | $29 |
| Blood Test - Blood Glucose (Sugar) Level | $13 | N/A | $13 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $33 | N/A | $33 |
| Blood Test - Blood Typing (ABO) | $117 | N/A | $117 |
| Blood Test - Blood Typing (Rh (D)) | $90 | N/A | $90 |
| Blood Test - C-reactive Protein (CRP) Level | $18 | N/A | $18 |
| Blood Test - Cholesterol Test, Lipid Panel | $45 | N/A | $45 |
| Blood Test - Clotting Time | $13 | N/A | $13 |
| Blood Test - Coagulation Assessment | $20 | N/A | $20 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $22 | N/A | $22 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $26 | N/A | $26 |
| Blood Test - Comprehensive Metabolic Panel | $36 | N/A | $36 |
| Blood Test - Creatinine Level | $17 | N/A | $17 |
| Blood Test - Electrolytes Panel | $27 | N/A | $27 |
| Blood Test - Ferritin (Blood Protein) Level | $46 | N/A | $46 |
| Blood Test - Folic Acid Level | $50 | N/A | $50 |
| Blood Test - General Health Panel | $120 | N/A | $120 |
| Blood Test - Hepatic (Liver) Function Panel | $28 | N/A | $28 |
| Blood Test - Hepatitis B Surface Antibody Level | $36 | N/A | $36 |
| Blood Test - Hepatitis C Antibody Level | $51 | N/A | $51 |
| Blood Test - Iron Level | $22 | N/A | $22 |
| Blood Test - Lipase (fat enzyme) Level | $23 | N/A | $23 |
| Blood Test - Magnesium Level | $23 | N/A | $23 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $63 | N/A | $63 |
| Blood Test - Renal (Kidney) Function Panel | $30 | N/A | $30 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $54 | N/A | $54 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $57 | N/A | $57 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $31 | N/A | $31 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $57 | N/A | $57 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $51 | N/A | $51 |
| Blood Test - Vitamin D-3 Level | $101 | N/A | $101 |
| Bone Density Scan (outpatient) | $351 | N/A | $351 |
| Colonoscopy - Diagnostic (outpatient) | $3,869 | N/A | $3,869 |
| Colonoscopy - With Biopsy (outpatient) | $4,669 | N/A | $4,669 |
| Colonoscopy - With Polyp Removal (outpatient) | $4,744 | N/A | $4,744 |
| CT Scan - Abdomen and Pelvis, with Contrast | $1,727 | N/A | $1,727 |
| CT Scan - Chest, with Contrast (outpatient) | $1,425 | N/A | $1,425 |
| CT Scan - Head/Brain, without Contrast | $370 | N/A | $370 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $457 | N/A | $457 |
| Emergency Department Visit - Low Complexity (outpatient) | $590 | N/A | $590 |
| Emergency Department Visit - Minor (outpatient) | $436 | N/A | $436 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $844 | N/A | $844 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $29 | N/A | $29 |
| Fetal Non-Stress Test | $730 | N/A | $730 |
| Hydration Infusion | $111 | N/A | $111 |
| Kidney Stone Removal (outpatient) | $8,703 | N/A | $8,703 |
| Lab Test - Creatinine Level | $18 | N/A | $18 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $42 | N/A | $42 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $210 | N/A | $210 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $35 | N/A | $35 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $120 | N/A | $120 |
| Lab Test - Detection test for Influenza Virus | $42 | N/A | $42 |
| Lab Test - Smear for Microorganism | $15 | N/A | $15 |
| Mammogram (outpatient) | $494 | N/A | $494 |
| MRI - Back (outpatient) | $772 | N/A | $772 |
| MRI - Brain (outpatient) | $1,579 | N/A | $1,579 |
| MRI - Knee (outpatient) | $772 | N/A | $772 |
| MRI - Pelvis (outpatient) | $1,489 | N/A | $1,489 |
| MRI - Shoulder, Elbow, or Wrist | $1,075 | N/A | $1,075 |
| Myocardial Imaging (outpatient) | $5,988 | N/A | $5,988 |
| Nasal Endoscopy - Diagnostic | $1,362 | N/A | $1,362 |
| Office Visit - Basic | $143 | N/A | $143 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $369 | N/A | $369 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $383 | N/A | $383 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $446 | N/A | $446 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $354 | N/A | $354 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $303 | N/A | $303 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $357 | N/A | $357 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $332 | N/A | $332 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $361 | N/A | $361 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $301 | N/A | $301 |
| Office Visit - Established Patient, High Complexity | $470 | N/A | $470 |
| Office Visit - Established Patient, Low Complexity | $235 | N/A | $235 |
| Office Visit - Established Patient, Moderate Complexity | $351 | N/A | $351 |
| Office Visit - New Patient, Low Complexity | $350 | N/A | $350 |
| Office Visit - New Patient, Minor | $236 | N/A | $236 |
| Office Visit - New Patient, Moderate Complexity | $534 | N/A | $534 |
| Pap Test, automated screening and manual rescreening | $126 | N/A | $126 |
| Pap Test, manual screening | $100 | N/A | $100 |
| Physical Therapy - Application of Mechanical Traction | $56 | 
Above Average
State Average: 3 | $56 |
| Physical Therapy - High Complexity Evaluation | $288 | 
Near Average
State Average: 1 | $288 |
| Physical Therapy - Low Complexity Evaluation | $288 |
Near Average
State Average: 1 | $288 |
| Physical Therapy - Manual Therapy | $106 | 
Below Average
State Average: 4 | $106 |
| Physical Therapy - Therapeutic Activities | $141 |
Below Average
State Average: 3 | $141 |
| Physical Therapy - Therapeutic Exercises | $114 |
Below Average
State Average: 4 | $114 |
| Physical Therapy - Walking Training, 15 minutes | $103 |
Near Average
State Average: 1 | $103 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $23 | N/A | $23 |
| Ultrasound - Abdominal, Complete | $620 | N/A | $620 |
| Ultrasound - Abdominal, Limited | $506 | N/A | $506 |
| Ultrasound - Breast (outpatient) | $976 | N/A | $976 |
| Ultrasound - Head and Neck | $492 | N/A | $492 |
| Ultrasound - Pelvic (outpatient) | $614 | N/A | $614 |
| Ultrasound - Pregnancy Follow-Up | $656 | N/A | $656 |
| Ultrasound - Transvaginal (non-maternity) | $572 | N/A | $572 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,330 | N/A | $5,330 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,417 | N/A | $5,417 |
| Urine Test - Automated with Microscope Examination | $11 | N/A | $11 |
| Urine Test - Automated without Microscope | $8 | N/A | $8 |
| Urine Test - Bacterial Culture | $31 | N/A | $31 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $27 | N/A | $27 |
| Urine Test - Chlamydia | $120 | N/A | $120 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $120 | N/A | $120 |
| Urine Test - Microalbumin (Protein) Level | $21 | N/A | $21 |
| Urine Test - Pregnancy | $24 | N/A | $24 |
| Urine Test - Urinalysis, Manual Test | $11 | N/A | $11 |
| Vaccine - Influenza for Injection into Muscle | $37 | N/A | $37 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $347 | N/A | $347 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $105 | N/A | $105 |
| X-Ray - Abdomen | $324 | N/A | $324 |
| X-Ray - Ankle (outpatient) | $480 | N/A | $480 |
| X-Ray - Chest (outpatient) | $456 | N/A | $456 |
| X-Ray - Foot (outpatient) | $410 | N/A | $410 |
| X-Ray - Hand | $500 | N/A | $500 |
| X-Ray - Knee (outpatient) | $302 | N/A | $302 |
| X-Ray - Neck, Cervical Spine | $449 | N/A | $449 |
| X-Ray - Shoulder (outpatient) | $452 | N/A | $452 |
| X-Ray - Spine (outpatient) | $322 | N/A | $322 |
