| Arthrocentesis (outpatient) | $601 | N/A | $601 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $55 | N/A | $55 |
| Blood Test - Cholesterol Test, Lipid Panel | $111 | N/A | $111 |
| Blood Test - General Health Panel | $316 | N/A | $316 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $129 | N/A | $129 |
| Blood Test - Vitamin D-3 Level | $247 | N/A | $247 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $522 | N/A | $522 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $28 | N/A | $28 |
| Lab Test - Detection test for Influenza Virus | $38 | N/A | $38 |
| Mammogram (outpatient) | $925 | N/A | $925 |
| Office Visit - Basic | $137 | N/A | $137 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $308 | N/A | $308 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $420 | N/A | $420 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $305 | N/A | $305 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | N/A | $281 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $269 | N/A | $269 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $275 | N/A | $275 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $294 | N/A | $294 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $246 | N/A | $246 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $231 | N/A | $231 |
| Office Visit - Established Patient, High Complexity | $255 | N/A | $255 |
| Office Visit - Established Patient, Low Complexity | $178 | N/A | $178 |
| Office Visit - Established Patient, Moderate Complexity | $199 | N/A | $199 |
| Office Visit - New Patient, Low Complexity | $247 | N/A | $247 |
| Office Visit - New Patient, Minor | $180 | N/A | $180 |
| Office Visit - New Patient, Moderate Complexity | $360 | N/A | $360 |
| Urine Test - Automated with Microscope Examination | $66 | N/A | $66 |
| Urine Test - Automated without Microscope | $9 | N/A | $9 |
| Urine Test - Pregnancy | $28 | N/A | $28 |
| Vaccine - Influenza for Injection into Muscle | $41 | N/A | $41 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $98 | N/A | $98 |
