| Arthrocentesis (outpatient) | $792 | N/A | $792 |
| Bacterial Culture - Aerobic Isolates | $55 | N/A | $55 |
| Bacterial Culture - Swab | $77 | N/A | $77 |
| Biopsy - Endometrial (Uterus) | $1,196 | N/A | $1,196 |
| Biopsy - Punch Biopsy of Skin | $828 | N/A | $828 |
| Blood Test - Basic Metabolic Panel | $78 | N/A | $78 |
| Blood Test - Blood Glucose (Sugar) Level | $35 | N/A | $35 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $44 | N/A | $44 |
| Blood Test - Blood Typing (ABO) | $59 | N/A | $59 |
| Blood Test - Blood Typing (Rh (D)) | $57 | N/A | $57 |
| Blood Test - C-reactive Protein (CRP) Level | $54 | N/A | $54 |
| Blood Test - Cholesterol Test, Lipid Panel | $116 | N/A | $116 |
| Blood Test - Clotting Time | $26 | N/A | $26 |
| Blood Test - Coagulation Assessment | $42 | N/A | $42 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $70 | N/A | $70 |
| Blood Test - Comprehensive Metabolic Panel | $105 | N/A | $105 |
| Blood Test - Creatinine Level | $24 | N/A | $24 |
| Blood Test - Ferritin (Blood Protein) Level | $147 | N/A | $147 |
| Blood Test - Folic Acid Level | $67 | N/A | $67 |
| Blood Test - General Health Panel | $252 | N/A | $252 |
| Blood Test - Hepatic (Liver) Function Panel | $105 | N/A | $105 |
| Blood Test - Hepatitis B Surface Antibody Level | $59 | N/A | $59 |
| Blood Test - Hepatitis C Antibody Level | $101 | N/A | $101 |
| Blood Test - Iron Binding Capacity | $89 | N/A | $89 |
| Blood Test - Iron Level | $88 | N/A | $88 |
| Blood Test - LDL Cholesterol Level | $77 | N/A | $77 |
| Blood Test - Lead Level | $63 | N/A | $63 |
| Blood Test - Lipase (fat enzyme) Level | $67 | N/A | $67 |
| Blood Test - Magnesium Level | $59 | N/A | $59 |
| Blood Test - Pregnancy (Obstetric) Panel | $494 | N/A | $494 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $91 | N/A | $91 |
| Blood Test - Renal (Kidney) Function Panel | $72 | N/A | $72 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $70 | N/A | $70 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $77 | N/A | $77 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $76 | N/A | $76 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $91 | N/A | $91 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $77 | N/A | $77 |
| Blood Test - Vitamin D-3 Level | $150 | N/A | $150 |
| Bone Density Scan (outpatient) | $491 | N/A | $491 |
| Colonoscopy - Diagnostic (outpatient) | $4,323 | N/A | $4,323 |
| Colonoscopy - With Biopsy (outpatient) | $5,340 | N/A | $5,340 |
| Colonoscopy - With Polyp Removal (outpatient) | $5,377 | N/A | $5,377 |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,134 | N/A | $3,134 |
| CT Scan - Chest, with Contrast (outpatient) | $2,052 | N/A | $2,052 |
| Destruction of Lesion (outpatient) | $436 | N/A | $436 |
| Developmental Screening | $28 | N/A | $28 |
| Electrocardiogram (ECG or EKG), Tracing | $551 | N/A | $551 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $376 | N/A | $376 |
| Emergency Department Visit - Low Complexity (outpatient) | $224 | N/A | $224 |
| Emergency Department Visit - Minor (outpatient) | $205 | N/A | $205 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $436 | N/A | $436 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $70 | N/A | $70 |
| Fetal Non-Stress Test | $1,815 | N/A | $1,815 |
| Gall Bladder Surgery (outpatient) | $37,537 | N/A | $37,537 |
| Lab Test - Creatinine Level | $55 | N/A | $55 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $62 | N/A | $62 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $210 | N/A | $210 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $69 | N/A | $69 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $33 | N/A | $33 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $134 | N/A | $134 |
| Lab Test - Detection test for Influenza Virus | $127 | N/A | $127 |
| Lab Test - Smear for Microorganism | $33 | N/A | $33 |
| Mammogram (outpatient) | $857 | N/A | $857 |
| MRI - Back (outpatient) | $2,759 | N/A | $2,759 |
| MRI - Brain (outpatient) | $5,341 | N/A | $5,341 |
| MRI - Knee (outpatient) | $2,003 | N/A | $2,003 |
| Myocardial Imaging (outpatient) | $5,639 | N/A | $5,639 |
| Office Visit - Basic | $195 | N/A | $195 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $231 | N/A | $231 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $247 | N/A | $247 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $239 | N/A | $239 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $279 | N/A | $279 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $224 | N/A | $224 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $201 | N/A | $201 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $190 | N/A | $190 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $212 | N/A | $212 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $212 | N/A | $212 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $268 | N/A | $268 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $190 | N/A | $190 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $173 | N/A | $173 |
| Office Visit - Established Patient, High Complexity | $347 | N/A | $347 |
| Office Visit - Established Patient, Low Complexity | $223 | N/A | $223 |
| Office Visit - Established Patient, Moderate Complexity | $255 | N/A | $255 |
| Office Visit - New Patient, Low Complexity | $244 | N/A | $244 |
| Office Visit - New Patient, Minor | $238 | N/A | $238 |
| Office Visit - New Patient, Moderate Complexity | $314 | N/A | $314 |
| Pap Test, automated screening and manual rescreening | $132 | N/A | $132 |
| Pap Test, manual screening | $137 | N/A | $137 |
| Physical Therapy - Low Complexity Evaluation | $263 | 
Near Average
State Average: 1 | $263 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $75 | 
Below Average
State Average: 3 | $75 |
| Physical Therapy - Manual Therapy | $75 |
Below Average
State Average: 4 | $75 |
| Physical Therapy - Moderate Complexity Evaluation | $263 |
Near Average
State Average: 1 | $263 |
| Physical Therapy - Neuromuscular Reeducation | $75 |
Below Average
State Average: 4 | $75 |
| Physical Therapy - Self-care or Home Management Training | $75 |
Near Average
State Average: 1 | $75 |
| Physical Therapy - Therapeutic Activities | $70 |
Below Average
State Average: 3 | $70 |
| Physical Therapy - Therapeutic Exercises | $75 |
Below Average
State Average: 4 | $75 |
| Physical Therapy - Ultrasound Therapy | $75 | 
Above Average
State Average: 3 | $75 |
| Physical Therapy - Walking Training, 15 minutes | $75 |
Above Average
State Average: 1 | $75 |
| Psychiatric Diagnostic Evaluation | $215 |
Near Average
State Average: 1 | $215 |
| Psychotherapy - 30 Minutes | $71 |
Above Average
State Average: 1 | $71 |
| Psychotherapy - 45 Minutes | $109 |
Below Average
State Average: 4 | $109 |
| Psychotherapy - Group Session | $62 |
Above Average
State Average: 5 | $62 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $60 | N/A | $60 |
| Ultrasound - Abdominal, Complete | $698 | N/A | $698 |
| Ultrasound - Abdominal, Limited | $521 | N/A | $521 |
| Ultrasound - Breast (outpatient) | $1,199 | N/A | $1,199 |
| Ultrasound - Head and Neck | $718 | N/A | $718 |
| Ultrasound - Pregnancy (outpatient) | $816 | N/A | $816 |
| Ultrasound - Pregnancy Follow-Up | $651 | N/A | $651 |
| Ultrasound - Transvaginal (non-maternity) | $1,202 | N/A | $1,202 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $8,386 | N/A | $8,386 |
| Urine Capacity Measurement | $633 | N/A | $633 |
| Urine Test - Automated with Microscope Examination | $44 | N/A | $44 |
| Urine Test - Automated without Microscope | $33 | N/A | $33 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $48 | N/A | $48 |
| Urine Test - Chlamydia | $156 | N/A | $156 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $156 | N/A | $156 |
| Urine Test - Microalbumin (Protein) Level | $74 | N/A | $74 |
| Urine Test - Pregnancy | $38 | N/A | $38 |
| Urine Test - Urinalysis, Manual Test | $18 | N/A | $18 |
| Vaccine - Influenza for Injection into Muscle | $32 | N/A | $32 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $298 | N/A | $298 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $64 | N/A | $64 |
| X-Ray - Abdomen | $369 | N/A | $369 |
| X-Ray - Ankle (outpatient) | $436 | N/A | $436 |
| X-Ray - Chest (outpatient) | $520 | N/A | $520 |
| X-Ray - Foot (outpatient) | $458 | N/A | $458 |
| X-Ray - Hand | $559 | N/A | $559 |
| X-Ray - Hip | $345 | N/A | $345 |
| X-Ray - Knee (outpatient) | $520 | N/A | $520 |
| X-Ray - Neck, Cervical Spine | $513 | N/A | $513 |
| X-Ray - Pelvis | $535 | N/A | $535 |
| X-Ray - Shoulder (outpatient) | $570 | N/A | $570 |
| X-Ray - Spine (outpatient) | $643 | N/A | $643 |
| X-Ray - Wrist (outpatient) | $479 | N/A | $479 |
