| Arthrocentesis (outpatient) | $897 | 0% | $897 |
| Bacterial Culture - Swab | $187 | 0% | $187 |
| Biopsy - Tangential Biopsy of Skin | $1,152 | 0% | $1,152 |
| Blood Test - Basic Metabolic Panel | $48 | 0% | $48 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $78 | 0% | $78 |
| Blood Test - Cholesterol Test, Lipid Panel | $123 | 0% | $123 |
| Blood Test - Clotting Time | $62 | 0% | $62 |
| Blood Test - Coagulation Assessment | $54 | 0% | $54 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $70 | 0% | $70 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $59 | 0% | $59 |
| Blood Test - Comprehensive Metabolic Panel | $65 | 0% | $65 |
| Blood Test - Ferritin (Blood Protein) Level | $83 | 0% | $83 |
| Blood Test - General Health Panel | $190 | 0% | $190 |
| Blood Test - Hepatitis C Antibody Level | $152 | 0% | $152 |
| Blood Test - Iron Level | $20 | 0% | $20 |
| Blood Test - LDL Cholesterol Level | $76 | 0% | $76 |
| 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 | $56 | 0% | $56 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $97 | 0% | $97 |
| Blood Test - Vitamin D-3 Level | $184 | 0% | $184 |
| Bone Density Scan (outpatient) | $709 | 0% | $709 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,715 | 0% | $2,715 |
| Destruction of Lesion (outpatient) | $621 | 0% | $621 |
| Destruction of Lesions, up to 14 | $413 | 0% | $413 |
| Detection test for Human Papillomavirus (HPV) | $192 | 0% | $192 |
| Electrocardiogram (ECG or EKG) | $626 | 0% | $626 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $197 | 0% | $197 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $149 | 0% | $149 |
| Mammogram (outpatient) | $523 | 0% | $523 |
| MRI - Back (outpatient) | $3,539 | 0% | $3,539 |
| MRI - Brain (outpatient) | $7,245 | 0% | $7,245 |
| 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 | $389 | 0% | $389 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $480 | 0% | $480 |
| 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 | $379 | 0% | $379 |
| 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 | $236 | 0% | $236 |
| Psychiatric Diagnostic Evaluation | $255 | 0% | $255 |
| Psychotherapy - 30 Minutes | $137 | 0% | $137 |
| Psychotherapy - 45 Minutes | $184 | 0% | $184 |
| Psychotherapy - Family Session | $236 | 0% | $236 |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $20 | 0% | $20 |
| Ultrasound - Breast (outpatient) | $831 | 0% | $831 |
| Ultrasound - Pregnancy (outpatient) | $716 | 0% | $716 |
| Ultrasound - Pregnancy Follow-Up | $510 | 0% | $510 |
| Ultrasound - Transvaginal (non-maternity) | $902 | 0% | $902 |
| Urine Test - Automated with Microscope Examination | $171 | 0% | $171 |
| Urine Test - Automated without Microscope | $191 | 0% | $191 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $87 | 0% | $87 |
| Urine Test - Chlamydia | $180 | 0% | $180 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $164 | 0% | $164 |
| Urine Test - Microalbumin (Protein) Level | $69 | 0% | $69 |
| 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 - Chest (outpatient) | $581 | 0% | $581 |
| X-Ray - Foot (outpatient) | $553 | 0% | $553 |
| X-Ray - Hand | $834 | 0% | $834 |
| X-Ray - Knee (outpatient) | $543 | 0% | $543 |
| X-Ray - Shoulder (outpatient) | $749 | 0% | $749 |
