| Bacterial Culture - Aerobic Isolates | $65 | N/A | $36 |
| Bacterial Culture - Swab | $100 | N/A | $55 |
| Blood Test - Basic Metabolic Panel | $100 | N/A | $55 |
| Blood Test - Blood Glucose (Sugar) Level | $49 | N/A | $27 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $41 | N/A | $23 |
| Blood Test - Blood Typing (ABO) | $82 | N/A | $45 |
| Blood Test - Blood Typing (Rh (D)) | $100 | N/A | $55 |
| Blood Test - C-reactive Protein (CRP) Level | $69 | N/A | $38 |
| Blood Test - Cholesterol Test, Lipid Panel | $151 | N/A | $83 |
| Blood Test - Clotting Time | $36 | N/A | $20 |
| Blood Test - Coagulation Assessment | $79 | N/A | $43 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $74 | N/A | $40 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $89 | N/A | $49 |
| Blood Test - Comprehensive Metabolic Panel | $121 | N/A | $66 |
| Blood Test - Creatinine Level | $58 | N/A | $32 |
| Blood Test - Ferritin (Blood Protein) Level | $116 | N/A | $64 |
| Blood Test - Folic Acid Level | $68 | N/A | $38 |
| Blood Test - General Health Panel | $352 | N/A | $193 |
| Blood Test - Hepatic (Liver) Function Panel | $95 | N/A | $52 |
| Blood Test - Hepatitis B Surface Antibody Level | $96 | N/A | $53 |
| Blood Test - Hepatitis C Antibody Level | $152 | N/A | $84 |
| Blood Test - Iron Binding Capacity | $72 | N/A | $40 |
| Blood Test - Iron Level | $75 | N/A | $41 |
| Blood Test - LDL Cholesterol Level | $44 | N/A | $24 |
| Blood Test - Lead Level | $106 | N/A | $58 |
| Blood Test - Lipase (fat enzyme) Level | $78 | N/A | $43 |
| Blood Test - Magnesium Level | $76 | N/A | $42 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $166 | N/A | $91 |
| Blood Test - Renal (Kidney) Function Panel | $72 | N/A | $40 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $60 | N/A | $33 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $142 | N/A | $78 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $114 | N/A | $63 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $169 | N/A | $93 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $135 | N/A | $74 |
| Blood Test - Vitamin D-3 Level | $208 | N/A | $114 |
| Bone Density Scan (outpatient) | $543 | N/A | $299 |
| Colonoscopy - Diagnostic (outpatient) | $4,312 | N/A | $2,372 |
| Colonoscopy - With Biopsy (outpatient) | $4,899 | N/A | $2,694 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,390 | N/A | $3,514 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,035 | N/A | $2,769 |
| CT Scan - Chest, with Contrast (outpatient) | $3,305 | N/A | $1,818 |
| Developmental Screening | $29 | N/A | $16 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $413 | N/A | $227 |
| Emergency Department Visit - Low Complexity (outpatient) | $323 | N/A | $178 |
| Emergency Department Visit - Minor (outpatient) | $197 | N/A | $109 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $606 | N/A | $333 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $102 | N/A | $56 |
| Hydration Infusion | $132 | N/A | $73 |
| Lab Test - Creatinine Level | $65 | N/A | $36 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $24 | N/A | $13 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $162 | N/A | $89 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $80 | N/A | $44 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $126 | N/A | $69 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $294 | N/A | $162 |
| Lab Test - Detection test for Influenza Virus | $99 | N/A | $54 |
| Lab Test - Smear for Microorganism | $51 | N/A | $28 |
| Mammogram (outpatient) | $925 | N/A | $509 |
| MRI - Back (outpatient) | $4,106 | N/A | $2,258 |
| MRI - Brain (outpatient) | $5,903 | N/A | $3,247 |
| MRI - Knee (outpatient) | $3,590 | N/A | $1,974 |
| MRI - Shoulder, Elbow, or Wrist | $3,956 | N/A | $2,176 |
| Office Visit - Basic | $95 | N/A | $52 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $284 | N/A | $156 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $288 | N/A | $158 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $332 | N/A | $182 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $260 | N/A | $143 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $243 | N/A | $133 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $225 | N/A | $124 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $247 | N/A | $136 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $248 | N/A | $136 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $270 | N/A | $148 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $228 | N/A | $125 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $201 | N/A | $110 |
| Office Visit - Established Patient, High Complexity | $253 | N/A | $139 |
| Office Visit - Established Patient, Low Complexity | $128 | N/A | $70 |
| Office Visit - Established Patient, Moderate Complexity | $188 | N/A | $103 |
| Office Visit - New Patient, Low Complexity | $213 | N/A | $117 |
| Office Visit - New Patient, Minor | $158 | N/A | $87 |
| Office Visit - New Patient, Moderate Complexity | $360 | N/A | $198 |
| Pap Test, automated screening and manual rescreening | $155 | N/A | $85 |
| Physical Therapy - High Complexity Evaluation | $301 | 
Near Average
State Average: 1 | $166 |
| Physical Therapy - Low Complexity Evaluation | $301 |
Near Average
State Average: 1 | $166 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $65 | 
Below Average
State Average: 3 | $36 |
| Physical Therapy - Manual Therapy | $144 | 
Above Average
State Average: 4 | $79 |
| Physical Therapy - Moderate Complexity Evaluation | $301 |
Near Average
State Average: 1 | $166 |
| Physical Therapy - Re-Evaluation | $181 |
Near Average
State Average: 1 | $99 |
| Physical Therapy - Self-care or Home Management Training | $99 |
Near Average
State Average: 1 | $54 |
| Physical Therapy - Therapeutic Activities | $111 |
Below Average
State Average: 3 | $61 |
| Physical Therapy - Therapeutic Exercises | $122 |
Below Average
State Average: 4 | $67 |
| Physical Therapy - Ultrasound Therapy | $63 |
Near Average
State Average: 3 | $35 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $71 | N/A | $39 |
| Ultrasound - Abdominal, Limited | $753 | N/A | $414 |
| Ultrasound - Breast (outpatient) | $1,216 | N/A | $669 |
| Ultrasound - Head and Neck | $819 | N/A | $450 |
| Ultrasound - Transvaginal (non-maternity) | $1,262 | N/A | $694 |
| Urine Test - Automated with Microscope Examination | $38 | N/A | $21 |
| Urine Test - Automated without Microscope | $30 | N/A | $17 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $67 | N/A | $37 |
| Urine Test - Chlamydia | $109 | N/A | $60 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $109 | N/A | $60 |
| Urine Test - Microalbumin (Protein) Level | $71 | N/A | $39 |
| Urine Test - Pregnancy | $71 | N/A | $39 |
| Urine Test - Urinalysis, Manual Test | $19 | N/A | $10 |
| Vaccine - Influenza for Injection into Muscle | $42 | N/A | $23 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $219 | N/A | $121 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $98 | N/A | $54 |
| X-Ray - Abdomen | $643 | N/A | $353 |
| X-Ray - Ankle (outpatient) | $558 | N/A | $307 |
| X-Ray - Chest (outpatient) | $651 | N/A | $358 |
| X-Ray - Foot (outpatient) | $586 | N/A | $322 |
| X-Ray - Hand | $618 | N/A | $340 |
| X-Ray - Hip | $753 | N/A | $414 |
| X-Ray - Knee (outpatient) | $622 | N/A | $342 |
| X-Ray - Shoulder (outpatient) | $494 | N/A | $272 |
| X-Ray - Spine (outpatient) | $488 | N/A | $269 |
| X-Ray - Wrist (outpatient) | $544 | N/A | $299 |
