| Arthrocentesis (outpatient) | $805 | 0% | $805 |
| Biopsy - Punch Biopsy of Skin | $1,124 | 0% | $1,124 |
| Biopsy - Tangential Biopsy of Skin | $1,300 | 0% | $1,300 |
| Blood Test - Basic Metabolic Panel | $102 | 0% | $102 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $23 | 0% | $23 |
| Blood Test - Cholesterol Test, Lipid Panel | $112 | 0% | $112 |
| Blood Test - Clotting Time | $62 | 0% | $62 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $62 | 0% | $62 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $29 | 0% | $29 |
| Blood Test - Comprehensive Metabolic Panel | $89 | 0% | $89 |
| Blood Test - General Health Panel | $199 | 0% | $199 |
| Blood Test - Hepatic (Liver) Function Panel | $74 | 0% | $74 |
| Blood Test - Hepatitis C Antibody Level | $131 | 0% | $131 |
| Blood Test - Iron Level | $69 | 0% | $69 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $184 | 0% | $184 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | 0% | $151 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 0% | $81 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $152 | 0% | $152 |
| Blood Test - Vitamin D-3 Level | $292 | 0% | $292 |
| Bone Density Scan (outpatient) | $681 | 0% | $681 |
| Destruction of Lesion (outpatient) | $611 | 0% | $611 |
| Destruction of Lesions, up to 14 | $701 | 0% | $701 |
| Detection test for Human Papillomavirus (HPV) | $234 | 0% | $234 |
| Electrocardiogram (ECG or EKG) | $551 | 0% | $551 |
| Lab Test - Detection test for Influenza Virus | $75 | 0% | $75 |
| Laryngoscopy - Diagnostic | $1,179 | 0% | $1,179 |
| Mammogram (outpatient) | $1,051 | 0% | $1,051 |
| Nasal Endoscopy - Diagnostic | $1,232 | 0% | $1,232 |
| Office Visit - Basic | $162 | 0% | $162 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $334 | 0% | $334 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $337 | 0% | $337 |
| 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 | $408 | 0% | $408 |
| 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 | $289 | 0% | $289 |
| 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 | $260 | 0% | $260 |
| Office Visit - New Patient, Moderate Complexity | $520 | 0% | $520 |
| Pap Test | $166 | 0% | $166 |
| Physical Therapy - Electrical Stimulation Therapy | $39 | 0% | $39 |
| Physical Therapy - Low Complexity Evaluation | $127 | 0% | $127 |
| Physical Therapy - Manual Therapy | $39 | 0% | $39 |
| Physical Therapy - Moderate Complexity Evaluation | $246 | 0% | $246 |
| Physical Therapy - Therapeutic Exercises | $39 | 0% | $39 |
| Psychiatric Diagnostic Evaluation | $195 | 0% | $195 |
| Psychotherapy - 30 Minutes | $75 | 0% | $75 |
| Psychotherapy - 45 Minutes | $120 | 0% | $120 |
| Psychotherapy - Group Session | $65 | 0% | $65 |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | 0% | $12 |
| Ultrasound - Pregnancy (outpatient) | $716 | 0% | $716 |
| Ultrasound - Pregnancy Follow-Up | $812 | 0% | $812 |
| Ultrasound - Transvaginal (non-maternity) | $1,418 | 0% | $1,418 |
| Urine Test - Automated with Microscope Examination | $54 | 0% | $54 |
| Urine Test - Automated without Microscope | $53 | 0% | $53 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $37 | 0% | $37 |
| Urine Test - Chlamydia | $218 | 0% | $218 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $218 | 0% | $218 |
| Urine Test - Microalbumin (Protein) Level | $48 | 0% | $48 |
| 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 - Ankle (outpatient) | $675 | 0% | $675 |
| X-Ray - Foot (outpatient) | $786 | 0% | $786 |
| X-Ray - Hand | $682 | 0% | $682 |
| X-Ray - Knee (outpatient) | $736 | 0% | $736 |
| X-Ray - Shoulder (outpatient) | $873 | 0% | $873 |
| X-Ray - Wrist (outpatient) | $878 | 0% | $878 |
