| Arthrocentesis (outpatient) | $1,668 | N/A | $1,668 |
| Bacterial Culture - Aerobic Isolates | $121 | N/A | $121 |
| Blood Test - Blood Glucose (Sugar) Level | $68 | N/A | $68 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $125 | N/A | $125 |
| Blood Test - Coagulation Assessment | $150 | N/A | $150 |
| Blood Test - Creatinine Level | $97 | N/A | $97 |
| Blood Test - Electrolytes Panel | $184 | N/A | $184 |
| Blood Test - Hepatitis B Surface Antibody Level | $226 | N/A | $226 |
| Blood Test - Hepatitis C Antibody Level | $183 | N/A | $183 |
| Blood Test - LDL Cholesterol Level | $105 | N/A | $105 |
| Blood Test - Lead Level | $118 | N/A | $118 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $188 | N/A | $188 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $203 | N/A | $203 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $151 | N/A | $151 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $187 | N/A | $187 |
| Blood Test - Vitamin D-3 Level | $266 | N/A | $266 |
| Colonoscopy - Diagnostic (outpatient) | $5,566 | N/A | $5,566 |
| Cystoscopy | $2,978 | N/A | $2,978 |
| Hydration Infusion | $213 | N/A | $213 |
| Lab Test - Creatinine Level | $83 | N/A | $83 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $219 | N/A | $219 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $167 | N/A | $167 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $223 | N/A | $223 |
| Lab Test - Detection test for Influenza Virus | $144 | N/A | $144 |
| Lab Test - Smear for Microorganism | $99 | N/A | $99 |
| MRI - Back (outpatient) | $1,917 | N/A | $1,917 |
| MRI - Knee (outpatient) | $1,870 | N/A | $1,870 |
| MRI - Shoulder, Elbow, or Wrist | $1,870 | N/A | $1,870 |
| Pap Test, manual screening | $161 | N/A | $161 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $45 | 
Above Average
State Average: 3 | $45 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $43 |
Above Average
State Average: 3 | $43 |
| Physical Therapy - Manual Therapy | $79 | 
Below Average
State Average: 4 | $79 |
| Physical Therapy - Neuromuscular Reeducation | $98 |
Below Average
State Average: 4 | $98 |
| Physical Therapy - Self-care or Home Management Training | $97 | 
Near Average
State Average: 1 | $97 |
| Physical Therapy - Therapeutic Exercises | $86 |
Below Average
State Average: 4 | $86 |
| Physical Therapy - Ultrasound Therapy | $37 |
Above Average
State Average: 3 | $37 |
| Psychotherapy - 30 Minutes | $117 |
Near Average
State Average: 1 | $117 |
| Psychotherapy - Group Session | $91 |
Above Average
State Average: 5 | $91 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $144 | N/A | $144 |
| Ultrasound - Abdominal, Limited | $891 | N/A | $891 |
| Urine Capacity Measurement | $891 | N/A | $891 |
| Urine Test - Automated with Microscope Examination | $116 | N/A | $116 |
| Urine Test - Automated without Microscope | $80 | N/A | $80 |
| Urine Test - Chlamydia | $230 | N/A | $230 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $225 | N/A | $225 |
| Urine Test - Microalbumin (Protein) Level | $103 | N/A | $103 |
| Urine Test - Pregnancy | $148 | N/A | $148 |
| Urine Test - Urinalysis, Manual Test | $41 | N/A | $41 |
| X-Ray - Chest (outpatient) | $1,154 | N/A | $1,154 |
| X-Ray - Foot (outpatient) | $896 | N/A | $896 |
| X-Ray - Hip | $1,151 | N/A | $1,151 |
| X-Ray - Shoulder (outpatient) | $642 | N/A | $642 |
| X-Ray - Spine (outpatient) | $1,042 | N/A | $1,042 |
