| Ambulance Service - Emergency Transport, Advanced Life Support | $1,820 | N/A | $765 |
| Arthrocentesis (outpatient) | $1,749 | N/A | $734 |
| Arthroscopic Knee Surgery (outpatient) | $14,213 | N/A | $5,969 |
| Arthroscopic Shoulder Surgery | $39,193 | N/A | $16,461 |
| Bacterial Culture - Aerobic Isolates | $102 | N/A | $43 |
| Bacterial Culture - Swab | $135 | N/A | $57 |
| Biopsy - Breast | $6,522 | N/A | $2,739 |
| Biopsy - Endometrial (Uterus) | $1,124 | N/A | $472 |
| Blood Test - Basic Metabolic Panel | $147 | N/A | $62 |
| Blood Test - Blood Glucose (Sugar) Level | $58 | N/A | $24 |
| Blood Test - Blood Typing (ABO) | $132 | N/A | $56 |
| Blood Test - Blood Typing (Rh (D)) | $102 | N/A | $43 |
| Blood Test - C-reactive Protein (CRP) Level | $79 | N/A | $33 |
| Blood Test - Clotting Time | $90 | N/A | $38 |
| Blood Test - Coagulation Assessment | $124 | N/A | $52 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $132 | N/A | $55 |
| Blood Test - Comprehensive Metabolic Panel | $176 | N/A | $74 |
| Blood Test - Creatinine Level | $55 | N/A | $23 |
| Blood Test - Electrolytes Panel | $120 | N/A | $50 |
| Blood Test - General Health Panel | $330 | N/A | $138 |
| Blood Test - Hepatic (Liver) Function Panel | $167 | N/A | $70 |
| Blood Test - Hepatitis B Surface Antibody Level | $221 | N/A | $93 |
| Blood Test - Iron Binding Capacity | $122 | N/A | $51 |
| Blood Test - Lipase (fat enzyme) Level | $142 | N/A | $60 |
| Blood Test - Magnesium Level | $112 | N/A | $47 |
| Blood Test - Pregnancy (Obstetric) Panel | $271 | N/A | $114 |
| Blood Test - Renal (Kidney) Function Panel | $251 | N/A | $105 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $250 | N/A | $105 |
| Bone Density Scan (outpatient) | $633 | N/A | $266 |
| Colonoscopy - Diagnostic (outpatient) | $4,703 | N/A | $1,975 |
| Colonoscopy - With Biopsy (outpatient) | $5,829 | N/A | $2,448 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,955 | N/A | $2,921 |
| CT Scan - Abdomen and Pelvis, with Contrast | $6,800 | N/A | $2,856 |
| CT Scan - Chest, with Contrast (outpatient) | $4,054 | N/A | $1,703 |
| CT Scan - Head/Brain, without Contrast | $2,748 | N/A | $1,154 |
| Cystoscopy | $8,532 | N/A | $3,584 |
| Emergency Department Visit - Low Complexity (outpatient) | $630 | N/A | $265 |
| Emergency Department Visit - Minor (outpatient) | $350 | N/A | $147 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,124 | N/A | $472 |
| Fetal Non-Stress Test | $1,470 | N/A | $617 |
| Gall Bladder Surgery (outpatient) | $25,657 | N/A | $10,776 |
| Hernia Repair - Laparoscopic (outpatient) | $27,878 | N/A | $11,709 |
| Hydration Infusion | $502 | N/A | $211 |
| Kidney Stone Removal (outpatient) | $13,324 | N/A | $5,596 |
| Lab Test - Creatinine Level | $79 | N/A | $33 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $104 | N/A | $44 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $209 | N/A | $88 |
| Mammogram (outpatient) | $916 | N/A | $385 |
| MRI - Back (outpatient) | $3,996 | N/A | $1,678 |
| MRI - Brain (outpatient) | $5,834 | N/A | $2,450 |
| MRI - Knee (outpatient) | $3,485 | N/A | $1,464 |
| MRI - Pelvis (outpatient) | $5,413 | N/A | $2,274 |
| MRI - Shoulder, Elbow, or Wrist | $3,591 | N/A | $1,508 |
| Myocardial Imaging (outpatient) | $10,061 | N/A | $4,225 |
| Office Visit - Established Patient, Low Complexity | $214 | N/A | $90 |
| Office Visit - Established Patient, Moderate Complexity | $326 | N/A | $137 |
| Physical Therapy - High Complexity Evaluation | $371 | 
Near Average
State Average: 1 | $156 |
| Physical Therapy - Low Complexity Evaluation | $356 |
Near Average
State Average: 1 | $150 |
| Physical Therapy - Manual Therapy | $149 |
Near Average
State Average: 4 | $63 |
| Physical Therapy - Moderate Complexity Evaluation | $371 |
Near Average
State Average: 1 | $156 |
| Physical Therapy - Re-Evaluation | $202 |
Near Average
State Average: 1 | $85 |
| Physical Therapy - Self-care or Home Management Training | $141 |
Near Average
State Average: 1 | $59 |
| Physical Therapy - Therapeutic Activities | $154 | 
Above Average
State Average: 3 | $65 |
| Physical Therapy - Therapeutic Exercises | $145 |
Near Average
State Average: 4 | $61 |
| Physical Therapy - Walking Training, 15 minutes | $138 |
Near Average
State Average: 1 | $58 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $88 | N/A | $37 |
| Tonsillectomy with Adenoidectomy (outpatient) | $12,609 | N/A | $5,296 |
| Ultrasound - Abdominal, Complete | $1,287 | N/A | $541 |
| Ultrasound - Abdominal, Limited | $994 | N/A | $418 |
| Ultrasound - Breast (outpatient) | $1,521 | N/A | $639 |
| Ultrasound - Head and Neck | $933 | N/A | $392 |
| Ultrasound - Pelvic (outpatient) | $1,083 | N/A | $455 |
| Ultrasound - Pregnancy (outpatient) | $1,353 | N/A | $568 |
| Ultrasound - Pregnancy Follow-Up | $1,605 | N/A | $674 |
| Ultrasound - Transvaginal (non-maternity) | $1,055 | N/A | $443 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $4,870 | N/A | $2,045 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,037 | N/A | $2,116 |
| Urine Capacity Measurement | $780 | N/A | $328 |
| Urine Test - Automated with Microscope Examination | $113 | N/A | $48 |
| Urine Test - Automated without Microscope | $47 | N/A | $20 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $93 | N/A | $39 |
| Urine Test - Microalbumin (Protein) Level | $83 | N/A | $35 |
| Urine Test - Pregnancy | $153 | N/A | $64 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $554 | N/A | $233 |
| X-Ray - Abdomen | $748 | N/A | $314 |
| X-Ray - Ankle (outpatient) | $620 | N/A | $260 |
| X-Ray - Chest (outpatient) | $730 | N/A | $307 |
| X-Ray - Foot (outpatient) | $631 | N/A | $265 |
| X-Ray - Hand | $752 | N/A | $316 |
| X-Ray - Hip | $784 | N/A | $329 |
| X-Ray - Knee (outpatient) | $827 | N/A | $347 |
| X-Ray - Middle Back, Thoracic Spine | $922 | N/A | $387 |
| X-Ray - Neck, Cervical Spine | $796 | N/A | $334 |
| X-Ray - Pelvis | $1,152 | N/A | $484 |
| X-Ray - Shoulder (outpatient) | $648 | N/A | $272 |
| X-Ray - Spine (outpatient) | $543 | N/A | $228 |
| X-Ray - Wrist (outpatient) | $614 | N/A | $258 |
