| Ambulance Service - Emergency Transport, Advanced Life Support | $1,382 | 38% | $857 |
| Ambulance Service - Mileage Rate for Ambulance Transport | $38 | 38% | $24 |
| Bacterial Culture - Swab | $35 | 38% | $22 |
| Blood Test - Basic Metabolic Panel | $16 | 38% | $10 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $19 | 38% | $12 |
| Blood Test - Cholesterol Test, Lipid Panel | $26 | 38% | $16 |
| Blood Test - Clotting Time | $7 | 38% | $5 |
| Blood Test - Coagulation Assessment | $12 | 38% | $7 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $13 | 38% | $8 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $15 | 38% | $9 |
| Blood Test - Comprehensive Metabolic Panel | $20 | 38% | $12 |
| Blood Test - Ferritin (Blood Protein) Level | $26 | 38% | $16 |
| Blood Test - Folic Acid Level | $28 | 38% | $18 |
| Blood Test - General Health Panel | $67 | 38% | $42 |
| Blood Test - Hepatic (Liver) Function Panel | $16 | 38% | $10 |
| Blood Test - Hepatitis C Antibody Level | $25 | 38% | $16 |
| Blood Test - Iron Level | $13 | 38% | $8 |
| Blood Test - Lipase (fat enzyme) Level | $14 | 38% | $8 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $28 | 38% | $18 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $33 | 38% | $20 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $17 | 38% | $10 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $32 | 38% | $20 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $23 | 38% | $14 |
| Blood Test - Vitamin D-3 Level | $56 | 38% | $35 |
| Bone Density Scan (outpatient) | $743 | 38% | $461 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,066 | 38% | $1,281 |
| CT Scan - Chest, with Contrast (outpatient) | $2,459 | 38% | $1,525 |
| Detection test for Human Papillomavirus (HPV) | $59 | 38% | $36 |
| Emergency Department Visit - Low Complexity (outpatient) | $716 | 38% | $444 |
| Emergency Department Visit - Minor (outpatient) | $426 | 38% | $264 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,838 | 38% | $1,139 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $17 | 38% | $10 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $89 | 38% | $55 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $42 | 38% | $26 |
| Lab Test - Detection test for Influenza Virus | $21 | 38% | $13 |
| Lab Test - Smear for Microorganism | $8 | 38% | $5 |
| Mammogram (outpatient) | $761 | 38% | $472 |
| MRI - Brain (outpatient) | $4,474 | 38% | $2,774 |
| Physical Therapy - High Complexity Evaluation | $378 | 38% | $234 |
| Physical Therapy - Low Complexity Evaluation | $378 | 38% | $234 |
| Physical Therapy - Manual Therapy | $90 | 38% | $56 |
| Physical Therapy - Moderate Complexity Evaluation | $378 | 38% | $234 |
| Physical Therapy - Neuromuscular Reeducation | $90 | 38% | $56 |
| Physical Therapy - Re-Evaluation | $202 | 38% | $125 |
| Physical Therapy - Therapeutic Activities | $90 | 38% | $56 |
| Physical Therapy - Therapeutic Exercises | $90 | 38% | $56 |
| Physical Therapy - Ultrasound Therapy | $90 | 38% | $56 |
| Strep Test (Streptococcus, group A) | $22 | 38% | $14 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | 38% | $7 |
| Ultrasound - Abdominal, Limited | $728 | 38% | $451 |
| Ultrasound - Head and Neck | $720 | 38% | $447 |
| Ultrasound - Pregnancy Follow-Up | $902 | 38% | $559 |
| Urine Test - Automated with Microscope Examination | $6 | 38% | $4 |
| Urine Test - Automated without Microscope | $3 | 38% | $2 |
| Urine Test - Bacterial Culture | $8 | 38% | $5 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $13 | 38% | $8 |
| Urine Test - Chlamydia | $48 | 38% | $30 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $49 | 38% | $31 |
| Urine Test - Microalbumin (Protein) Level | $11 | 38% | $7 |
| Urine Test - Pregnancy | $13 | 38% | $8 |
| X-Ray - Abdomen | $423 | 38% | $262 |
| X-Ray - Ankle (outpatient) | $424 | 38% | $263 |
| X-Ray - Chest (outpatient) | $362 | 38% | $225 |
| X-Ray - Foot (outpatient) | $364 | 38% | $226 |
| X-Ray - Hand | $479 | 38% | $297 |
| X-Ray - Knee (outpatient) | $382 | 38% | $237 |
| X-Ray - Shoulder (outpatient) | $370 | 38% | $229 |
| X-Ray - Spine (outpatient) | $296 | 38% | $183 |
