| Arthrocentesis (outpatient) | $516 | 0% | $516 |
| Bacterial Culture - Swab | $187 | 0% | $187 |
| Biopsy - Punch Biopsy of Skin | $1,855 | 0% | $1,855 |
| Biopsy - Tangential Biopsy of Skin | $1,516 | 0% | $1,516 |
| Blood Test - Basic Metabolic Panel | $161 | 0% | $161 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $106 | 0% | $106 |
| Blood Test - Cholesterol Test, Lipid Panel | $150 | 0% | $150 |
| Blood Test - Clotting Time | $13 | 0% | $13 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $106 | 0% | $106 |
| Blood Test - Comprehensive Metabolic Panel | $213 | 0% | $213 |
| Blood Test - Ferritin (Blood Protein) Level | $78 | 0% | $78 |
| Blood Test - Folic Acid Level | $125 | 0% | $125 |
| Blood Test - General Health Panel | $208 | 0% | $208 |
| Blood Test - Hepatitis C Antibody Level | $138 | 0% | $138 |
| Blood Test - Iron Level | $57 | 0% | $57 |
| Blood Test - Lipase (fat enzyme) Level | $30 | 0% | $30 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $122 | 0% | $122 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $95 | 0% | $95 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $126 | 0% | $126 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $145 | 0% | $145 |
| Blood Test - Vitamin D-3 Level | $203 | 0% | $203 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,582 | 0% | $2,582 |
| Destruction of Lesion (outpatient) | $604 | 0% | $604 |
| Destruction of Lesions, up to 14 | $655 | 0% | $655 |
| Detection test for Human Papillomavirus (HPV) | $349 | 0% | $349 |
| Electrocardiogram (ECG or EKG) | $895 | 0% | $895 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $132 | 0% | $132 |
| Lab Test - Detection test for Influenza Virus | $85 | 0% | $85 |
| Lab Test - Smear for Microorganism | $109 | 0% | $109 |
| Laryngoscopy - Diagnostic | $1,300 | 0% | $1,300 |
| Mammogram (outpatient) | $947 | 0% | $947 |
| MRI - Knee (outpatient) | $3,288 | 0% | $3,288 |
| Nasal Endoscopy - Diagnostic | $1,324 | 0% | $1,324 |
| Office Visit - Basic | $158 | 0% | $158 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $254 | 0% | $254 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $442 | 0% | $442 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $442 | 0% | $442 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $361 | 0% | $361 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $322 | 0% | $322 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $368 | 0% | $368 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $310 | 0% | $310 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $247 | 0% | $247 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $387 | 0% | $387 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $422 | 0% | $422 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $256 | 0% | $256 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $196 | 0% | $196 |
| Office Visit - Established Patient, High Complexity | $482 | 0% | $482 |
| Office Visit - Established Patient, Low Complexity | $160 | 0% | $160 |
| Office Visit - Established Patient, Moderate Complexity | $357 | 0% | $357 |
| Office Visit - New Patient, Low Complexity | $236 | 0% | $236 |
| Office Visit - New Patient, Minor | $177 | 0% | $177 |
| Office Visit - New Patient, Moderate Complexity | $359 | 0% | $359 |
| Pap Test | $227 | 0% | $227 |
| Physical Therapy - Moderate Complexity Evaluation | $342 | 0% | $342 |
| Physical Therapy - Therapeutic Exercises | $138 | 0% | $138 |
| Psychiatric Diagnostic Evaluation | $193 | 0% | $193 |
| Psychotherapy - 30 Minutes | $161 | 0% | $161 |
| Psychotherapy - Group Session | $129 | 0% | $129 |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $106 | 0% | $106 |
| Urine Capacity Measurement | $507 | 0% | $507 |
| Urine Test - Automated with Microscope Examination | $40 | 0% | $40 |
| Urine Test - Automated without Microscope | $56 | 0% | $56 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $111 | 0% | $111 |
| Urine Test - Chlamydia | $221 | 0% | $221 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $238 | 0% | $238 |
| Urine Test - Microalbumin (Protein) Level | $89 | 0% | $89 |
| Urine Test - Pregnancy | $59 | 0% | $59 |
| Urine Test - Urinalysis, Manual Test | $55 | 0% | $55 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $654 | 0% | $654 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $141 | 0% | $141 |
| X-Ray - Chest (outpatient) | $581 | 0% | $581 |
| X-Ray - Knee (outpatient) | $927 | 0% | $927 |
