| Ambulance Service - Emergency Transport, Advanced Life Support | $1,449 | N/A | $869 |
| Ambulance Service - Emergency Transport, Basic Life Support | $1,136 | N/A | $682 |
| Ambulance Service - Mileage Rate for Ambulance Transport | $39 | N/A | $24 |
| Bacterial Culture - Aerobic Isolates | $13 | N/A | $8 |
| Bacterial Culture - Swab | $35 | N/A | $21 |
| Blood Test - Basic Metabolic Panel | $16 | N/A | $9 |
| Blood Test - Blood Glucose (Sugar) Level | $7 | N/A | $4 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $19 | N/A | $11 |
| Blood Test - Blood Typing (ABO) | $5 | N/A | $3 |
| Blood Test - Blood Typing (Rh (D)) | $5 | N/A | $3 |
| Blood Test - C-reactive Protein (CRP) Level | $9 | N/A | $6 |
| Blood Test - Cholesterol Test, Lipid Panel | $26 | N/A | $16 |
| Blood Test - Clotting Time | $7 | N/A | $4 |
| Blood Test - Coagulation Assessment | $12 | N/A | $7 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $13 | N/A | $8 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $15 | N/A | $9 |
| Blood Test - Comprehensive Metabolic Panel | $20 | N/A | $12 |
| Blood Test - Creatinine Level | $9 | N/A | $6 |
| Blood Test - Ferritin (Blood Protein) Level | $26 | N/A | $16 |
| Blood Test - Folic Acid Level | $28 | N/A | $17 |
| Blood Test - General Health Panel | $35 | N/A | $21 |
| Blood Test - Hepatic (Liver) Function Panel | $16 | N/A | $9 |
| Blood Test - Hepatitis C Antibody Level | $25 | N/A | $15 |
| Blood Test - Iron Binding Capacity | $17 | N/A | $10 |
| Blood Test - Iron Level | $13 | N/A | $8 |
| Blood Test - Lead Level | $23 | N/A | $14 |
| Blood Test - Lipase (fat enzyme) Level | $14 | N/A | $8 |
| Blood Test - Magnesium Level | $13 | N/A | $8 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $28 | N/A | $17 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $26 | N/A | $16 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $33 | N/A | $20 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $17 | N/A | $10 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $32 | N/A | $19 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $23 | N/A | $14 |
| Blood Test - Vitamin D-3 Level | $56 | N/A | $33 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,098 | N/A | $1,259 |
| Emergency Department Visit - Low Complexity (outpatient) | $716 | N/A | $430 |
| Emergency Department Visit - Minor (outpatient) | $426 | N/A | $256 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,838 | N/A | $1,103 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $17 | N/A | $10 |
| Hydration Infusion | $114 | N/A | $69 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $100 | N/A | $60 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $89 | N/A | $54 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $42 | N/A | $25 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $59 | N/A | $35 |
| Lab Test - Detection test for Influenza Virus | $21 | N/A | $13 |
| Lab Test - Smear for Microorganism | $8 | N/A | $5 |
| Mammogram (outpatient) | $819 | N/A | $491 |
| MRI - Brain (outpatient) | $4,471 | N/A | $2,683 |
| Physical Therapy - High Complexity Evaluation | $378 | 
Near Average
State Average: 1 | $227 |
| Physical Therapy - Low Complexity Evaluation | $378 |
Near Average
State Average: 1 | $227 |
| Physical Therapy - Manual Therapy | $90 | 
Below Average
State Average: 4 | $54 |
| Physical Therapy - Moderate Complexity Evaluation | $378 |
Near Average
State Average: 1 | $227 |
| Physical Therapy - Neuromuscular Reeducation | $90 | 
Above Average
State Average: 4 | $54 |
| Physical Therapy - Re-Evaluation | $202 |
Near Average
State Average: 1 | $121 |
| Physical Therapy - Therapeutic Activities | $90 |
Above Average
State Average: 3 | $54 |
| Physical Therapy - Therapeutic Exercises | $90 |
Below Average
State Average: 4 | $54 |
| Physical Therapy - Ultrasound Therapy | $90 |
Below Average
State Average: 3 | $54 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | N/A | $7 |
| Ultrasound - Abdominal, Limited | $728 | N/A | $437 |
| Ultrasound - Head and Neck | $720 | N/A | $432 |
| Ultrasound - Pregnancy Follow-Up | $902 | N/A | $541 |
| Urine Test - Automated with Microscope Examination | $6 | N/A | $4 |
| Urine Test - Automated without Microscope | $3 | N/A | $2 |
| Urine Test - Bacterial Culture | $8 | N/A | $5 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $8 | N/A | $5 |
| Urine Test - Chlamydia | $48 | N/A | $29 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $49 | N/A | $30 |
| Urine Test - Microalbumin (Protein) Level | $11 | N/A | $6 |
| Urine Test - Pregnancy | $13 | N/A | $8 |
| X-Ray - Abdomen | $396 | N/A | $238 |
| X-Ray - Chest (outpatient) | $362 | N/A | $217 |
| X-Ray - Foot (outpatient) | $364 | N/A | $219 |
| X-Ray - Hand | $353 | N/A | $212 |
| X-Ray - Spine (outpatient) | $361 | N/A | $217 |
