| Ambulance Service - Emergency Transport, Advanced Life Support | $1,298 | N/A | $1,298 |
| Ambulance Service - Emergency Transport, Basic Life Support | $840 | N/A | $840 |
| Ambulance Service - Mileage Rate for Ambulance Transport | $32 | N/A | $32 |
| Ambulance Service - Non-Emergency Transport, Advanced Life Support | $1,193 | N/A | $1,193 |
| Ambulance Service - Non-Emergency Transport, Basic Life Support | $735 | N/A | $735 |
| Bacterial Culture - Aerobic Isolates | $27 | N/A | $27 |
| Bacterial Culture - Swab | $91 | N/A | $91 |
| Biopsy - Breast | $4,435 | N/A | $4,435 |
| Blood Test - Basic Metabolic Panel | $59 | N/A | $59 |
| Blood Test - Blood Glucose (Sugar) Level | $28 | N/A | $28 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $68 | N/A | $68 |
| Blood Test - Blood Typing (ABO) | $79 | N/A | $79 |
| Blood Test - Blood Typing (Rh (D)) | $101 | N/A | $101 |
| Blood Test - C-reactive Protein (CRP) Level | $74 | N/A | $74 |
| Blood Test - Cholesterol Test, Lipid Panel | $85 | N/A | $85 |
| Blood Test - Clotting Time | $42 | N/A | $42 |
| Blood Test - Coagulation Assessment | $53 | N/A | $53 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $32 | N/A | $32 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $59 | N/A | $59 |
| Blood Test - Comprehensive Metabolic Panel | $86 | N/A | $86 |
| Blood Test - Creatinine Level | $37 | N/A | $37 |
| Blood Test - Electrolytes Panel | $79 | N/A | $79 |
| Blood Test - Ferritin (Blood Protein) Level | $96 | N/A | $96 |
| Blood Test - Folic Acid Level | $95 | N/A | $95 |
| Blood Test - General Health Panel | $266 | N/A | $266 |
| Blood Test - Hepatic (Liver) Function Panel | $68 | N/A | $68 |
| Blood Test - Hepatitis B Surface Antibody Level | $45 | N/A | $45 |
| Blood Test - Hepatitis C Antibody Level | $54 | N/A | $54 |
| Blood Test - Iron Level | $59 | N/A | $59 |
| Blood Test - LDL Cholesterol Level | $42 | N/A | $42 |
| Blood Test - Lead Level | $35 | N/A | $35 |
| Blood Test - Lipase (fat enzyme) Level | $50 | N/A | $50 |
| Blood Test - Magnesium Level | $49 | N/A | $49 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $104 | N/A | $104 |
| Blood Test - Renal (Kidney) Function Panel | $55 | N/A | $55 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $116 | N/A | $116 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $97 | N/A | $97 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $101 | N/A | $101 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $103 | N/A | $103 |
| Blood Test - Vitamin D-3 Level | $129 | N/A | $129 |
| Bone Density Scan (outpatient) | $493 | N/A | $493 |
| Colonoscopy - Diagnostic (outpatient) | $4,161 | N/A | $4,161 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,221 | N/A | $6,221 |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,800 | N/A | $3,800 |
| CT Scan - Chest, with Contrast (outpatient) | $2,303 | N/A | $2,303 |
| Emergency Department Visit - Low Complexity (outpatient) | $314 | N/A | $314 |
| Emergency Department Visit - Minor (outpatient) | $238 | N/A | $238 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $435 | N/A | $435 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $88 | N/A | $88 |
| Fetal Non-Stress Test | $1,160 | N/A | $1,160 |
| Hydration Infusion | $134 | N/A | $134 |
| Lab Test - Creatinine Level | $32 | N/A | $32 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $77 | N/A | $77 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $45 | N/A | $45 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $92 | N/A | $92 |
| Lab Test - Detection test for Influenza Virus | $61 | N/A | $61 |
| Lab Test - Smear for Microorganism | $41 | N/A | $41 |
| Mammogram (outpatient) | $903 | N/A | $903 |
| MRI - Brain (outpatient) | $2,195 | N/A | $2,195 |
| MRI - Knee (outpatient) | $1,999 | N/A | $1,999 |
| Office Visit - Basic | $163 | N/A | $163 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $368 | N/A | $368 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $389 | N/A | $389 |
| Physical Therapy - Application of Hot or Cold Pack | $69 | 
Above Average
State Average: 3 | $69 |
| Physical Therapy - Low Complexity Evaluation | $160 | 
Near Average
State Average: 1 | $160 |
| Physical Therapy - Manual Therapy | $110 | 
Below Average
State Average: 4 | $110 |
| Physical Therapy - Moderate Complexity Evaluation | $176 |
Near Average
State Average: 1 | $176 |
| Physical Therapy - Neuromuscular Reeducation | $85 |
Below Average
State Average: 4 | $85 |
| Physical Therapy - Self-care or Home Management Training | $93 |
Near Average
State Average: 1 | $93 |
| Physical Therapy - Therapeutic Activities | $112 |
Above Average
State Average: 3 | $112 |
| Physical Therapy - Therapeutic Exercises | $103 |
Below Average
State Average: 4 | $103 |
| Physical Therapy - Ultrasound Therapy | $75 |
Near Average
State Average: 3 | $75 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $48 | N/A | $48 |
| Ultrasound - Abdominal, Complete | $1,380 | N/A | $1,380 |
| Ultrasound - Abdominal, Limited | $775 | N/A | $775 |
| Ultrasound - Breast (outpatient) | $1,529 | N/A | $1,529 |
| Ultrasound - Head and Neck | $706 | N/A | $706 |
| Ultrasound - Pelvic (outpatient) | $921 | N/A | $921 |
| Ultrasound - Pregnancy Follow-Up | $402 | N/A | $402 |
| Ultrasound - Transvaginal (non-maternity) | $1,030 | N/A | $1,030 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $6,365 | N/A | $6,365 |
| Urine Test - Automated with Microscope Examination | $29 | N/A | $29 |
| Urine Test - Bacterial Culture | $45 | N/A | $45 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $71 | N/A | $71 |
| Urine Test - Chlamydia | $146 | N/A | $146 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $146 | N/A | $146 |
| Urine Test - Microalbumin (Protein) Level | $37 | N/A | $37 |
| Urine Test - Pregnancy | $34 | N/A | $34 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $127 | N/A | $127 |
| X-Ray - Abdomen | $264 | N/A | $264 |
| X-Ray - Ankle (outpatient) | $493 | N/A | $493 |
| X-Ray - Chest (outpatient) | $510 | N/A | $510 |
| X-Ray - Foot (outpatient) | $516 | N/A | $516 |
| X-Ray - Knee (outpatient) | $426 | N/A | $426 |
| X-Ray - Neck, Cervical Spine | $711 | N/A | $711 |
| X-Ray - Spine (outpatient) | $664 | N/A | $664 |
