| Arthrocentesis (outpatient) | $1,466 | N/A | $147 |
| Bacterial Culture - Swab | $167 | N/A | $17 |
| Biopsy - Breast | $13,465 | N/A | $1,346 |
| Blood Test - Blood Typing (ABO) | $111 | N/A | $11 |
| Blood Test - Blood Typing (Rh (D)) | $99 | N/A | $10 |
| Blood Test - Clotting Time | $97 | N/A | $10 |
| Blood Test - Coagulation Assessment | $215 | N/A | $22 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $138 | N/A | $14 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | N/A | $3 |
| Blood Test - Folic Acid Level | $182 | N/A | $18 |
| Blood Test - Hepatic (Liver) Function Panel | $150 | N/A | $15 |
| Blood Test - Hepatitis B Surface Antibody Level | $230 | N/A | $23 |
| Blood Test - Hepatitis C Antibody Level | $222 | N/A | $22 |
| Blood Test - Lipase (fat enzyme) Level | $153 | N/A | $15 |
| Blood Test - Magnesium Level | $120 | N/A | $12 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $174 | N/A | $17 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $243 | N/A | $24 |
| Bone Density Scan (outpatient) | $1,136 | N/A | $114 |
| Colonoscopy - Diagnostic (outpatient) | $5,614 | N/A | $561 |
| Colonoscopy - With Biopsy (outpatient) | $7,645 | N/A | $765 |
| Colonoscopy - With Polyp Removal (outpatient) | $7,401 | N/A | $740 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,287 | N/A | $529 |
| CT Scan - Chest, with Contrast (outpatient) | $5,085 | N/A | $509 |
| CT Scan - Head/Brain, without Contrast | $4,540 | N/A | $454 |
| Cystoscopy | $3,557 | N/A | $356 |
| Emergency Department Visit - Low Complexity (outpatient) | $1,338 | N/A | $134 |
| Emergency Department Visit - Minor (outpatient) | $816 | N/A | $82 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $3,251 | N/A | $325 |
| Fetal Non-Stress Test | $1,365 | N/A | $137 |
| Hydration Infusion | $356 | N/A | $36 |
| Lab Test - Creatinine Level | $112 | N/A | $11 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $205 | N/A | $20 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $210 | N/A | $21 |
| Lab Test - Smear for Microorganism | $76 | N/A | $8 |
| Laryngoscopy - Diagnostic | $457 | N/A | $46 |
| Mammogram (outpatient) | $1,046 | N/A | $105 |
| MRI - Back (outpatient) | $5,073 | N/A | $507 |
| MRI - Brain (outpatient) | $8,067 | N/A | $807 |
| MRI - Pelvis (outpatient) | $6,840 | N/A | $684 |
| Nasal Endoscopy - Diagnostic | $683 | N/A | $68 |
| Office Visit - Basic | $89 | N/A | $9 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $234 | N/A | $23 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $234 | N/A | $23 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $272 | N/A | $27 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $205 | N/A | $20 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $205 | N/A | $20 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $224 | N/A | $22 |
| Office Visit - Established Patient, Low Complexity | $147 | N/A | $15 |
| Office Visit - Established Patient, Moderate Complexity | $217 | N/A | $22 |
| Office Visit - New Patient, Low Complexity | $218 | N/A | $22 |
| Office Visit - New Patient, Minor | $151 | N/A | $15 |
| Office Visit - New Patient, Moderate Complexity | $334 | N/A | $33 |
| Pap Test, automated screening and manual rescreening | $254 | N/A | $25 |
| Pap Test, manual screening | $150 | N/A | $15 |
| Physical Therapy - High Complexity Evaluation | $547 | 
Near Average
State Average: 1 | $55 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $174 | N/A | $17 |
| Ultrasound - Abdominal, Complete | $1,587 | N/A | $159 |
| Ultrasound - Abdominal, Limited | $1,030 | N/A | $103 |
| Ultrasound - Breast (outpatient) | $1,605 | N/A | $161 |
| Ultrasound - Head and Neck | $1,288 | N/A | $129 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,165 | N/A | $517 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $6,666 | N/A | $667 |
| Urine Capacity Measurement | $911 | N/A | $91 |
| Urine Test - Automated with Microscope Examination | $135 | N/A | $14 |
| Urine Test - Automated without Microscope | $89 | N/A | $9 |
| Urine Test - Chlamydia | $143 | N/A | $14 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $143 | N/A | $14 |
| Urine Test - Pregnancy | $28 | N/A | $3 |
| Urine Test - Urinalysis, Manual Test | $12 | N/A | $1 |
| Vaccine - Influenza for Injection into Muscle | $62 | N/A | $6 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $130 | N/A | $13 |
| X-Ray - Abdomen | $1,490 | N/A | $149 |
| X-Ray - Ankle (outpatient) | $783 | N/A | $78 |
| X-Ray - Chest (outpatient) | $840 | N/A | $84 |
| X-Ray - Foot (outpatient) | $889 | N/A | $89 |
| X-Ray - Hand | $1,078 | N/A | $108 |
| X-Ray - Hip | $742 | N/A | $74 |
| X-Ray - Knee (outpatient) | $835 | N/A | $84 |
| X-Ray - Neck, Cervical Spine | $687 | N/A | $69 |
| X-Ray - Shoulder (outpatient) | $721 | N/A | $72 |
| X-Ray - Spine (outpatient) | $824 | N/A | $82 |
| X-Ray - Wrist (outpatient) | $1,274 | N/A | $127 |
