| Arthrocentesis (outpatient) | $648 | N/A | $389 |
| Bacterial Culture - Aerobic Isolates | $64 | N/A | $38 |
| Bacterial Culture - Swab | $71 | N/A | $43 |
| Biopsy - Breast | $2,689 | N/A | $1,613 |
| Biopsy - Endometrial (Uterus) | $1,239 | N/A | $743 |
| Blood Test - Basic Metabolic Panel | $109 | N/A | $66 |
| Blood Test - Blood Glucose (Sugar) Level | $57 | N/A | $34 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $91 | N/A | $55 |
| Blood Test - Blood Typing (ABO) | $44 | N/A | $26 |
| Blood Test - Blood Typing (Rh (D)) | $44 | N/A | $26 |
| Blood Test - C-reactive Protein (CRP) Level | $67 | N/A | $40 |
| Blood Test - Cholesterol Test, Lipid Panel | $95 | N/A | $57 |
| Blood Test - Clotting Time | $54 | N/A | $32 |
| Blood Test - Coagulation Assessment | $83 | N/A | $50 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $83 | N/A | $50 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $103 | N/A | $62 |
| Blood Test - Comprehensive Metabolic Panel | $137 | N/A | $82 |
| Blood Test - Creatinine Level | $58 | N/A | $35 |
| Blood Test - Electrolytes Panel | $91 | N/A | $55 |
| Blood Test - Ferritin (Blood Protein) Level | $176 | N/A | $106 |
| Blood Test - Folic Acid Level | $72 | N/A | $43 |
| Blood Test - General Health Panel | $462 | N/A | $277 |
| Blood Test - Hepatic (Liver) Function Panel | $106 | N/A | $64 |
| Blood Test - Hepatitis B Surface Antibody Level | $119 | N/A | $71 |
| Blood Test - Hepatitis C Antibody Level | $142 | N/A | $85 |
| Blood Test - Iron Binding Capacity | $113 | N/A | $68 |
| Blood Test - Iron Level | $84 | N/A | $50 |
| Blood Test - LDL Cholesterol Level | $58 | N/A | $35 |
| Blood Test - Lead Level | $87 | N/A | $52 |
| Blood Test - Lipase (fat enzyme) Level | $89 | N/A | $54 |
| Blood Test - Magnesium Level | $87 | N/A | $52 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $100 | N/A | $60 |
| Blood Test - Renal (Kidney) Function Panel | $112 | N/A | $67 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $143 | N/A | $86 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $97 | N/A | $58 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $69 | N/A | $42 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $143 | N/A | $86 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $84 | N/A | $50 |
| Blood Test - Vitamin D-3 Level | $200 | N/A | $120 |
| Bone Density Scan (outpatient) | $708 | N/A | $425 |
| Colonoscopy - Diagnostic (outpatient) | $5,520 | N/A | $3,312 |
| Colonoscopy - With Biopsy (outpatient) | $8,001 | N/A | $4,801 |
| Colonoscopy - With Polyp Removal (outpatient) | $8,912 | N/A | $5,347 |
| CT Scan - Abdomen and Pelvis, with Contrast | $7,264 | N/A | $4,358 |
| CT Scan - Chest, with Contrast (outpatient) | $4,160 | N/A | $2,496 |
| CT Scan - Head/Brain, without Contrast | $4,352 | N/A | $2,611 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $486 | N/A | $291 |
| Emergency Department Visit - Low Complexity (outpatient) | $457 | N/A | $274 |
| Emergency Department Visit - Minor (outpatient) | $235 | N/A | $141 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $927 | N/A | $556 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $134 | N/A | $81 |
| Fetal Non-Stress Test | $931 | N/A | $559 |
| Gall Bladder Surgery (outpatient) | $31,683 | N/A | $19,010 |
| Hernia Repair - Laparoscopic (outpatient) | $28,263 | N/A | $16,958 |
| Hydration Infusion | $285 | N/A | $171 |
| Lab Test - Creatinine Level | $42 | N/A | $25 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $54 | N/A | $32 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $158 | N/A | $95 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $111 | N/A | $67 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $97 | N/A | $58 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $249 | N/A | $149 |
| Lab Test - Smear for Microorganism | $39 | N/A | $23 |
| Laryngoscopy - Diagnostic | $719 | N/A | $432 |
| Mammogram (outpatient) | $1,129 | N/A | $677 |
| MRI - Back (outpatient) | $3,942 | N/A | $2,365 |
| MRI - Brain (outpatient) | $7,621 | N/A | $4,573 |
| MRI - Knee (outpatient) | $1,600 | N/A | $960 |
| MRI - Pelvis (outpatient) | $7,097 | N/A | $4,258 |
| MRI - Shoulder, Elbow, or Wrist | $2,734 | N/A | $1,641 |
| Myocardial Imaging (outpatient) | $10,578 | N/A | $6,347 |
| Nasal Endoscopy - Diagnostic | $951 | N/A | $571 |
| Office Visit - Basic | $198 | N/A | $119 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $389 | N/A | $233 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $468 | N/A | $281 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $297 | N/A | $178 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $296 | N/A | $178 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $311 | N/A | $186 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $326 | N/A | $195 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $290 | N/A | $174 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $265 | N/A | $159 |
| Office Visit - Established Patient, High Complexity | $432 | N/A | $259 |
| Office Visit - Established Patient, Low Complexity | $226 | N/A | $135 |
| Office Visit - Established Patient, Moderate Complexity | $305 | N/A | $183 |
| Office Visit - New Patient, Low Complexity | $303 | N/A | $182 |
| Office Visit - New Patient, Minor | $213 | N/A | $128 |
| Office Visit - New Patient, Moderate Complexity | $486 | N/A | $291 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $65 | 
Above Average
State Average: 3 | $39 |
| Physical Therapy - Electrical Stimulation Therapy | $72 |
Above Average
State Average: 3 | $43 |
| Physical Therapy - High Complexity Evaluation | $443 | 
Near Average
State Average: 1 | $266 |
| Physical Therapy - Low Complexity Evaluation | $443 |
Near Average
State Average: 1 | $266 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $54 | 
Below Average
State Average: 3 | $32 |
| Physical Therapy - Manual Therapy | $143 |
Near Average
State Average: 4 | $86 |
| Physical Therapy - Moderate Complexity Evaluation | $425 |
Near Average
State Average: 1 | $255 |
| Physical Therapy - Self-care or Home Management Training | $125 |
Near Average
State Average: 1 | $75 |
| Physical Therapy - Therapeutic Exercises | $156 |
Above Average
State Average: 4 | $94 |
| Physical Therapy - Ultrasound Therapy | $70 |
Near Average
State Average: 3 | $42 |
| Physical Therapy - Walking Training, 15 minutes | $146 |
Near Average
State Average: 1 | $88 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $53 | N/A | $32 |
| Tonsillectomy with Adenoidectomy (outpatient) | $14,817 | N/A | $8,890 |
| Ultrasound - Abdominal, Complete | $1,719 | N/A | $1,032 |
| Ultrasound - Abdominal, Limited | $1,063 | N/A | $638 |
| Ultrasound - Breast (outpatient) | $2,008 | N/A | $1,205 |
| Ultrasound - Head and Neck | $1,109 | N/A | $665 |
| Ultrasound - Pregnancy (outpatient) | $905 | N/A | $543 |
| Ultrasound - Pregnancy Follow-Up | $924 | N/A | $554 |
| Ultrasound - Transvaginal (non-maternity) | $1,047 | N/A | $628 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,522 | N/A | $3,313 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $7,330 | N/A | $4,398 |
| Urine Capacity Measurement | $500 | N/A | $300 |
| Urine Test - Automated with Microscope Examination | $48 | N/A | $29 |
| Urine Test - Automated without Microscope | $30 | N/A | $18 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $64 | N/A | $38 |
| Urine Test - Chlamydia | $131 | N/A | $79 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $131 | N/A | $79 |
| Urine Test - Microalbumin (Protein) Level | $29 | N/A | $18 |
| Urine Test - Pregnancy | $90 | N/A | $54 |
| Urine Test - Urinalysis, Manual Test | $24 | N/A | $14 |
| Vaccine - Influenza for Injection into Muscle | $25 | N/A | $15 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $433 | N/A | $260 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $67 | N/A | $40 |
| X-Ray - Abdomen | $762 | N/A | $457 |
| X-Ray - Ankle (outpatient) | $731 | N/A | $438 |
| X-Ray - Chest (outpatient) | $999 | N/A | $599 |
| X-Ray - Foot (outpatient) | $971 | N/A | $583 |
| X-Ray - Hand | $1,104 | N/A | $662 |
| X-Ray - Hip | $900 | N/A | $540 |
| X-Ray - Knee (outpatient) | $524 | N/A | $315 |
| X-Ray - Middle Back, Thoracic Spine | $1,243 | N/A | $746 |
| X-Ray - Neck, Cervical Spine | $941 | N/A | $564 |
| X-Ray - Pelvis | $912 | N/A | $547 |
| X-Ray - Shoulder (outpatient) | $820 | N/A | $492 |
| X-Ray - Spine (outpatient) | $1,142 | N/A | $685 |
| X-Ray - Wrist (outpatient) | $1,032 | N/A | $619 |
