| Arthrocentesis (outpatient) | $579 | 0% | $579 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $55 | 0% | $55 |
| Blood Test - Cholesterol Test, Lipid Panel | $111 | 0% | $111 |
| Blood Test - General Health Panel | $316 | 0% | $316 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $129 | 0% | $129 |
| Blood Test - Vitamin D-3 Level | $247 | 0% | $247 |
| Lab Test - Detection test for Influenza Virus | $38 | 0% | $38 |
| Mammogram (outpatient) | $914 | 0% | $914 |
| Office Visit - Basic | $137 | 0% | $137 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $308 | 0% | $308 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $305 | 0% | $305 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | 0% | $281 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $269 | 0% | $269 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $275 | 0% | $275 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $294 | 0% | $294 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $246 | 0% | $246 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $231 | 0% | $231 |
| Office Visit - Established Patient, High Complexity | $255 | 0% | $255 |
| Office Visit - Established Patient, Low Complexity | $178 | 0% | $178 |
| Office Visit - Established Patient, Moderate Complexity | $199 | 0% | $199 |
| Office Visit - New Patient, Low Complexity | $247 | 0% | $247 |
| Office Visit - New Patient, Minor | $180 | 0% | $180 |
| Office Visit - New Patient, Moderate Complexity | $360 | 0% | $360 |
| Strep Test (Streptococcus, group A) | $28 | 0% | $28 |
| Urine Test - Automated with Microscope Examination | $66 | 0% | $66 |
| Urine Test - Automated without Microscope | $9 | 0% | $9 |
| Urine Test - Pregnancy | $28 | 0% | $28 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $98 | 0% | $98 |
