| Arthrocentesis (outpatient) | $345 | 0% | $345 |
| Bacterial Culture - Aerobic Isolates | $19 | 0% | $19 |
| Biopsy - Punch Biopsy of Skin | $614 | 0% | $614 |
| 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 | $13 | 0% | $13 |
| 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 - Electrolytes Panel | $23 | 0% | $23 |
| 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 | $27 | 0% | $27 |
| Blood Test - Iron Level | $22 | 0% | $22 |
| Blood Test - LDL Cholesterol Level | $32 | 0% | $32 |
| Blood Test - Lipase (fat enzyme) Level | $21 | 0% | $21 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $61 | 0% | $61 |
| Blood Test - Renal (Kidney) Function Panel | $28 | 0% | $28 |
| 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 | $155 | 0% | $155 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $49 | 0% | $49 |
| Blood Test - Vitamin D-3 Level | $99 | 0% | $99 |
| Destruction of Lesion (outpatient) | $658 | 0% | $658 |
| Electrocardiogram (ECG or EKG) | $402 | 0% | $402 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $72 | 0% | $72 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $32 | 0% | $32 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $25 | 0% | $25 |
| Lab Test - Detection test for Influenza Virus | $40 | 0% | $40 |
| Laryngoscopy - Diagnostic | $623 | 0% | $623 |
| Mammogram (outpatient) | $916 | 0% | $916 |
| Nasal Endoscopy - Diagnostic | $792 | 0% | $792 |
| Office Visit - Basic | $109 | 0% | $109 |
| 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 | $330 | 0% | $330 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $318 | 0% | $318 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $370 | 0% | $370 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $291 | 0% | $291 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $267 | 0% | $267 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $261 | 0% | $261 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $287 | 0% | $287 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $292 | 0% | $292 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $312 | 0% | $312 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $260 | 0% | $260 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $245 | 0% | $245 |
| Office Visit - Established Patient, High Complexity | $361 | 0% | $361 |
| Office Visit - Established Patient, Low Complexity | $171 | 0% | $171 |
| Office Visit - Established Patient, Moderate Complexity | $268 | 0% | $268 |
| Office Visit - New Patient, Low Complexity | $270 | 0% | $270 |
| Office Visit - New Patient, Minor | $186 | 0% | $186 |
| Office Visit - New Patient, Moderate Complexity | $408 | 0% | $408 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $53 | 0% | $53 |
| Physical Therapy - Application of Mechanical Traction | $53 | 0% | $53 |
| Physical Therapy - Electrical Stimulation Therapy | $53 | 0% | $53 |
| Physical Therapy - Low Complexity Evaluation | $210 | 0% | $210 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $47 | 0% | $47 |
| Physical Therapy - Manual Therapy | $74 | 0% | $74 |
| Physical Therapy - Moderate Complexity Evaluation | $210 | 0% | $210 |
| Physical Therapy - Neuromuscular Reeducation | $79 | 0% | $79 |
| Physical Therapy - Re-Evaluation | $95 | 0% | $95 |
| Physical Therapy - Self-care or Home Management Training | $95 | 0% | $95 |
| Physical Therapy - Therapeutic Activities | $100 | 0% | $100 |
| Physical Therapy - Therapeutic Exercises | $79 | 0% | $79 |
| Physical Therapy - Ultrasound Therapy | $37 | 0% | $37 |
| Strep Test (Streptococcus, group A) | $40 | 0% | $40 |
| Urine Capacity Measurement | $418 | 0% | $418 |
| Urine Test - Automated with Microscope Examination | $11 | 0% | $11 |
| Urine Test - Automated without Microscope | $7 | 0% | $7 |
| 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 | $21 | 0% | $21 |
| Urine Test - Urinalysis, Manual Test | $8 | 0% | $8 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $358 | 0% | $358 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $78 | 0% | $78 |
| X-Ray - Ankle (outpatient) | $397 | 0% | $397 |
| X-Ray - Foot (outpatient) | $305 | 0% | $305 |
| X-Ray - Hand | $441 | 0% | $441 |
| X-Ray - Hip | $303 | 0% | $303 |
| X-Ray - Knee (outpatient) | $410 | 0% | $410 |
| X-Ray - Middle Back, Thoracic Spine | $416 | 0% | $416 |
| X-Ray - Shoulder (outpatient) | $387 | 0% | $387 |
| X-Ray - Spine (outpatient) | $487 | 0% | $487 |
| X-Ray - Wrist (outpatient) | $314 | 0% | $314 |
