| Arthrocentesis (outpatient) | $381 | 0% | $381 |
| Biopsy - Punch Biopsy of Skin | $1,000 | 0% | $1,000 |
| Biopsy - Tangential Biopsy of Skin | $788 | 0% | $788 |
| Blood Test - Basic Metabolic Panel | $55 | 0% | $55 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $35 | 0% | $35 |
| Blood Test - Cholesterol Test, Lipid Panel | $147 | 0% | $147 |
| Blood Test - Clotting Time | $15 | 0% | $15 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $43 | 0% | $43 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $44 | 0% | $44 |
| Blood Test - Comprehensive Metabolic Panel | $92 | 0% | $92 |
| Blood Test - Ferritin (Blood Protein) Level | $101 | 0% | $101 |
| Blood Test - Folic Acid Level | $152 | 0% | $152 |
| Blood Test - General Health Panel | $277 | 0% | $277 |
| Blood Test - Hepatic (Liver) Function Panel | $106 | 0% | $106 |
| Blood Test - Hepatitis C Antibody Level | $124 | 0% | $124 |
| Blood Test - Iron Level | $47 | 0% | $47 |
| Blood Test - Lipase (fat enzyme) Level | $65 | 0% | $65 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $115 | 0% | $115 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $109 | 0% | $109 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $138 | 0% | $138 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $111 | 0% | $111 |
| Blood Test - Vitamin D-3 Level | $289 | 0% | $289 |
| Destruction of Lesion (outpatient) | $404 | 0% | $404 |
| Destruction of Lesions, up to 14 | $411 | 0% | $411 |
| Electrocardiogram (ECG or EKG) | $470 | 0% | $470 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $111 | 0% | $111 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $114 | 0% | $114 |
| Lab Test - Detection test for Influenza Virus | $35 | 0% | $35 |
| Mammogram (outpatient) | $1,198 | 0% | $1,198 |
| Office Visit - Basic | $92 | 0% | $92 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $228 | 0% | $228 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $256 | 0% | $256 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $275 | 0% | $275 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $307 | 0% | $307 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $227 | 0% | $227 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $224 | 0% | $224 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $200 | 0% | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $239 | 0% | $239 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $240 | 0% | $240 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $263 | 0% | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $195 | 0% | $195 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $195 | 0% | $195 |
| Office Visit - Established Patient, High Complexity | $307 | 0% | $307 |
| Office Visit - Established Patient, Low Complexity | $153 | 0% | $153 |
| Office Visit - Established Patient, Moderate Complexity | $228 | 0% | $228 |
| Office Visit - New Patient, Low Complexity | $228 | 0% | $228 |
| Office Visit - New Patient, Minor | $159 | 0% | $159 |
| Office Visit - New Patient, Moderate Complexity | $349 | 0% | $349 |
| Pap Test | $254 | 0% | $254 |
| Physical Therapy - Low Complexity Evaluation | $243 | 0% | $243 |
| Physical Therapy - Manual Therapy | $97 | 0% | $97 |
| Physical Therapy - Therapeutic Exercises | $133 | 0% | $133 |
| Psychiatric Diagnostic Evaluation | $255 | 0% | $255 |
| Psychotherapy - 30 Minutes | $137 | 0% | $137 |
| Psychotherapy - 45 Minutes | $158 | 0% | $158 |
| Psychotherapy - 60 Minutes | $158 | 0% | $158 |
| Psychotherapy - Group Session | $63 | 0% | $63 |
| Strep Test (Streptococcus, group A) | $44 | 0% | $44 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $93 | 0% | $93 |
| Ultrasound - Breast (outpatient) | $1,604 | 0% | $1,604 |
| Urine Capacity Measurement | $352 | 0% | $352 |
| Urine Test - Automated with Microscope Examination | $113 | 0% | $113 |
| Urine Test - Automated without Microscope | $17 | 0% | $17 |
| Urine Test - Bacterial Culture | $31 | 0% | $31 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $85 | 0% | $85 |
| Urine Test - Chlamydia | $120 | 0% | $120 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $174 | 0% | $174 |
| Urine Test - Microalbumin (Protein) Level | $77 | 0% | $77 |
| Urine Test - Pregnancy | $18 | 0% | $18 |
| Urine Test - Urinalysis, Manual Test | $5 | 0% | $5 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $341 | 0% | $341 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $112 | 0% | $112 |
| X-Ray - Foot (outpatient) | $691 | 0% | $691 |
| X-Ray - Hand | $885 | 0% | $885 |
| X-Ray - Shoulder (outpatient) | $723 | 0% | $723 |
