| Arthrocentesis (outpatient) | $618 | 0% | $618 |
| Biopsy - Punch Biopsy of Skin | $444 | 0% | $444 |
| Biopsy - Tangential Biopsy of Skin | $512 | 0% | $512 |
| Blood Test - Basic Metabolic Panel | $18 | 0% | $18 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $21 | 0% | $21 |
| Blood Test - Cholesterol Test, Lipid Panel | $103 | 0% | $103 |
| Blood Test - Clotting Time | $16 | 0% | $16 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | 0% | $33 |
| Blood Test - Comprehensive Metabolic Panel | $48 | 0% | $48 |
| Blood Test - Ferritin (Blood Protein) Level | $86 | 0% | $86 |
| Blood Test - General Health Panel | $190 | 0% | $190 |
| Blood Test - Hepatitis C Antibody Level | $112 | 0% | $112 |
| Blood Test - Iron Level | $32 | 0% | $32 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 0% | $112 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $109 | 0% | $109 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $123 | 0% | $123 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $163 | 0% | $163 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $111 | 0% | $111 |
| Blood Test - Vitamin D-3 Level | $68 | 0% | $68 |
| Destruction of Lesion (outpatient) | $373 | 0% | $373 |
| Detection test for Human Papillomavirus (HPV) | $178 | 0% | $178 |
| Electrocardiogram (ECG or EKG) | $1,019 | 0% | $1,019 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $176 | 0% | $176 |
| Lab Test - Detection test for Influenza Virus | $26 | 0% | $26 |
| Mammogram (outpatient) | $934 | 0% | $934 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $263 | 0% | $263 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $310 | 0% | $310 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $294 | 0% | $294 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $341 | 0% | $341 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $247 | 0% | $247 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $205 | 0% | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $263 | 0% | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $263 | 0% | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $289 | 0% | $289 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $284 | 0% | $284 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $236 | 0% | $236 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $231 | 0% | $231 |
| Office Visit - Established Patient, High Complexity | $289 | 0% | $289 |
| Office Visit - Established Patient, Low Complexity | $189 | 0% | $189 |
| Office Visit - Established Patient, Moderate Complexity | $263 | 0% | $263 |
| Office Visit - New Patient, Low Complexity | $221 | 0% | $221 |
| Office Visit - New Patient, Moderate Complexity | $341 | 0% | $341 |
| Pap Test | $130 | 0% | $130 |
| Psychiatric Diagnostic Evaluation | $263 | 0% | $263 |
| Psychotherapy - 45 Minutes | $184 | 0% | $184 |
| Strep Test (Streptococcus, group A) | $26 | 0% | $26 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $19 | 0% | $19 |
| Urine Test - Automated with Microscope Examination | $38 | 0% | $38 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $76 | 0% | $76 |
| Urine Test - Chlamydia | $129 | 0% | $129 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $129 | 0% | $129 |
| Urine Test - Microalbumin (Protein) Level | $72 | 0% | $72 |
| Urine Test - Pregnancy | $21 | 0% | $21 |
| Urine Test - Urinalysis, Manual Test | $5 | 0% | $5 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $268 | 0% | $268 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $68 | 0% | $68 |
