| Arthrocentesis (outpatient) | $868 | 0% | $868 |
| Bacterial Culture - Swab | $187 | 0% | $187 |
| Biopsy - Punch Biopsy of Skin | $1,908 | 0% | $1,908 |
| Biopsy - Tangential Biopsy of Skin | $1,613 | 0% | $1,613 |
| Blood Test - Basic Metabolic Panel | $48 | 0% | $48 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $69 | 0% | $69 |
| Blood Test - Cholesterol Test, Lipid Panel | $132 | 0% | $132 |
| Blood Test - Clotting Time | $62 | 0% | $62 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $55 | 0% | $55 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $70 | 0% | $70 |
| Blood Test - Comprehensive Metabolic Panel | $55 | 0% | $55 |
| Blood Test - Ferritin (Blood Protein) Level | $110 | 0% | $110 |
| Blood Test - General Health Panel | $253 | 0% | $253 |
| Blood Test - Hepatic (Liver) Function Panel | $54 | 0% | $54 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 0% | $112 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $104 | 0% | $104 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $111 | 0% | $111 |
| Bone Density Scan (outpatient) | $681 | 0% | $681 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,625 | 0% | $2,625 |
| Destruction of Lesion (outpatient) | $693 | 0% | $693 |
| Destruction of Lesions, up to 14 | $758 | 0% | $758 |
| Detection test for Human Papillomavirus (HPV) | $188 | 0% | $188 |
| Electrocardiogram (ECG or EKG) | $551 | 0% | $551 |
| Mammogram (outpatient) | $523 | 0% | $523 |
| MRI - Back (outpatient) | $3,405 | 0% | $3,405 |
| MRI - Brain (outpatient) | $7,041 | 0% | $7,041 |
| MRI - Knee (outpatient) | $3,140 | 0% | $3,140 |
| Office Visit - Basic | $162 | 0% | $162 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $294 | 0% | $294 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $468 | 0% | $468 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $461 | 0% | $461 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $521 | 0% | $521 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $294 | 0% | $294 |
| 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 | $370 | 0% | $370 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $403 | 0% | $403 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $440 | 0% | $440 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $310 | 0% | $310 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $294 | 0% | $294 |
| Office Visit - Established Patient, High Complexity | $492 | 0% | $492 |
| Office Visit - Established Patient, Low Complexity | $226 | 0% | $226 |
| Office Visit - Established Patient, Moderate Complexity | $344 | 0% | $344 |
| Office Visit - New Patient, Low Complexity | $344 | 0% | $344 |
| Office Visit - New Patient, Minor | $273 | 0% | $273 |
| Office Visit - New Patient, Moderate Complexity | $520 | 0% | $520 |
| Pap Test | $236 | 0% | $236 |
| Physical Therapy - Therapeutic Exercises | $85 | 0% | $85 |
| Psychotherapy - 30 Minutes | $169 | 0% | $169 |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
| Ultrasound - Breast (outpatient) | $864 | 0% | $864 |
| Ultrasound - Pelvic (outpatient) | $572 | 0% | $572 |
| Ultrasound - Pregnancy (outpatient) | $716 | 0% | $716 |
| Ultrasound - Pregnancy Follow-Up | $614 | 0% | $614 |
| Ultrasound - Transvaginal (non-maternity) | $1,418 | 0% | $1,418 |
| Urine Test - Automated with Microscope Examination | $54 | 0% | $54 |
| Urine Test - Automated without Microscope | $191 | 0% | $191 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $87 | 0% | $87 |
| Urine Test - Pregnancy | $59 | 0% | $59 |
| Urine Test - Urinalysis, Manual Test | $55 | 0% | $55 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $624 | 0% | $624 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $141 | 0% | $141 |
| X-Ray - Ankle (outpatient) | $553 | 0% | $553 |
| X-Ray - Chest (outpatient) | $581 | 0% | $581 |
| X-Ray - Foot (outpatient) | $755 | 0% | $755 |
| X-Ray - Hand | $620 | 0% | $620 |
| X-Ray - Hip | $649 | 0% | $649 |
| X-Ray - Knee (outpatient) | $460 | 0% | $460 |
| X-Ray - Shoulder (outpatient) | $587 | 0% | $587 |
