| Arthrocentesis (outpatient) | $332 | 0% | $332 |
| Bacterial Culture - Aerobic Isolates | $19 | 0% | $19 |
| Blood Test - Basic Metabolic Panel | $28 | 0% | $28 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $33 | 0% | $33 |
| Blood Test - Cholesterol Test, Lipid Panel | $60 | 0% | $60 |
| Blood Test - Clotting Time | $12 | 0% | $12 |
| Blood Test - Coagulation Assessment | $47 | 0% | $47 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $22 | 0% | $22 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $26 | 0% | $26 |
| Blood Test - Comprehensive Metabolic Panel | $35 | 0% | $35 |
| Blood Test - Ferritin (Blood Protein) Level | $45 | 0% | $45 |
| Blood Test - Folic Acid Level | $49 | 0% | $49 |
| Blood Test - General Health Panel | $104 | 0% | $104 |
| Blood Test - Hepatic (Liver) Function Panel | $36 | 0% | $36 |
| Blood Test - Hepatitis C Antibody Level | $82 | 0% | $82 |
| Blood Test - Iron Level | $22 | 0% | $22 |
| Blood Test - Lipase (fat enzyme) Level | $51 | 0% | $51 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $61 | 0% | $61 |
| Blood Test - Renal (Kidney) Function Panel | $30 | 0% | $30 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $56 | 0% | $56 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $29 | 0% | $29 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $230 | 0% | $230 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $49 | 0% | $49 |
| Blood Test - Vitamin D-3 Level | $99 | 0% | $99 |
| Destruction of Lesion (outpatient) | $373 | 0% | $373 |
| Detection test for Human Papillomavirus (HPV) | $284 | 0% | $284 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $63 | 0% | $63 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $78 | 0% | $78 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $100 | 0% | $100 |
| Lab Test - Detection test for Influenza Virus | $40 | 0% | $40 |
| Laryngoscopy - Diagnostic | $499 | 0% | $499 |
| Mammogram (outpatient) | $916 | 0% | $916 |
| Nasal Endoscopy - Diagnostic | $667 | 0% | $667 |
| Office Visit - Basic | $89 | 0% | $89 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $279 | 0% | $279 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $255 | 0% | $255 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $234 | 0% | $234 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $341 | 0% | $341 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $268 | 0% | $268 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $205 | 0% | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $247 | 0% | $247 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $205 | 0% | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $205 | 0% | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $224 | 0% | $224 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $187 | 0% | $187 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $184 | 0% | $184 |
| Office Visit - Established Patient, High Complexity | $318 | 0% | $318 |
| Office Visit - Established Patient, Low Complexity | $147 | 0% | $147 |
| Office Visit - Established Patient, Moderate Complexity | $263 | 0% | $263 |
| Office Visit - New Patient, Low Complexity | $219 | 0% | $219 |
| Office Visit - New Patient, Minor | $186 | 0% | $186 |
| Office Visit - New Patient, Moderate Complexity | $383 | 0% | $383 |
| Pap Test | $128 | 0% | $128 |
| Psychotherapy - 30 Minutes | $89 | 0% | $89 |
| Psychotherapy - 45 Minutes | $112 | 0% | $112 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $98 | 0% | $98 |
| Urine Test - Automated with Microscope Examination | $11 | 0% | $11 |
| Urine Test - Automated without Microscope | $8 | 0% | $8 |
| Urine Test - Bacterial Culture | $38 | 0% | $38 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $41 | 0% | $41 |
| Urine Test - Chlamydia | $117 | 0% | $117 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $117 | 0% | $117 |
| Urine Test - Microalbumin (Protein) Level | $19 | 0% | $19 |
| Urine Test - Pregnancy | $27 | 0% | $27 |
| Urine Test - Urinalysis, Manual Test | $8 | 0% | $8 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $407 | 0% | $407 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $130 | 0% | $130 |
