| Bacterial Culture - Aerobic Isolates | $33 | 0% | $33 |
| Bacterial Culture - Swab | $51 | 0% | $51 |
| Blood Test - Basic Metabolic Panel | $64 | 0% | $64 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $59 | 0% | $59 |
| Blood Test - Cholesterol Test, Lipid Panel | $76 | 0% | $76 |
| Blood Test - Clotting Time | $65 | 0% | $65 |
| Blood Test - Coagulation Assessment | $104 | 0% | $104 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $38 | 0% | $38 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $35 | 0% | $35 |
| Blood Test - Comprehensive Metabolic Panel | $79 | 0% | $79 |
| Blood Test - Electrolytes Panel | $35 | 0% | $35 |
| Blood Test - Ferritin (Blood Protein) Level | $80 | 0% | $80 |
| Blood Test - Folic Acid Level | $81 | 0% | $81 |
| Blood Test - General Health Panel | $229 | 0% | $229 |
| Blood Test - Hepatic (Liver) Function Panel | $64 | 0% | $64 |
| Blood Test - Hepatitis C Antibody Level | $104 | 0% | $104 |
| Blood Test - LDL Cholesterol Level | $54 | 0% | $54 |
| Blood Test - Lipase (fat enzyme) Level | $54 | 0% | $54 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $106 | 0% | $106 |
| Blood Test - Renal (Kidney) Function Panel | $64 | 0% | $64 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $116 | 0% | $116 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $46 | 0% | $46 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $100 | 0% | $100 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $65 | 0% | $65 |
| Blood Test - Vitamin D-3 Level | $203 | 0% | $203 |
| Colonoscopy - Diagnostic (outpatient) | $4,641 | 0% | $4,641 |
| Colonoscopy - With Biopsy (outpatient) | $5,481 | 0% | $5,481 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,290 | 0% | $2,290 |
| Detection test for Human Papillomavirus (HPV) | $201 | 0% | $201 |
| Emergency Department Visit - Low Complexity (outpatient) | $660 | 0% | $660 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $660 | 0% | $660 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $46 | 0% | $46 |
| Fetal Non-Stress Test | $2,018 | 0% | $2,018 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $77 | 0% | $77 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $170 | 0% | $170 |
| Lab Test - Detection test for Influenza Virus | $36 | 0% | $36 |
| Lab Test - Smear for Microorganism | $17 | 0% | $17 |
| Mammogram (outpatient) | $783 | 0% | $783 |
| MRI - Back (outpatient) | $2,907 | 0% | $2,907 |
| MRI - Brain (outpatient) | $3,361 | 0% | $3,361 |
| MRI - Knee (outpatient) | $2,616 | 0% | $2,616 |
| MRI - Shoulder, Elbow, or Wrist | $2,616 | 0% | $2,616 |
| Office Visit - Basic | $137 | 0% | $137 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $299 | 0% | $299 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $411 | 0% | $411 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $439 | 0% | $439 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $265 | 0% | $265 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $244 | 0% | $244 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $234 | 0% | $234 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $255 | 0% | $255 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $305 | 0% | $305 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $319 | 0% | $319 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $233 | 0% | $233 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $218 | 0% | $218 |
| Office Visit - Established Patient, High Complexity | $420 | 0% | $420 |
| Office Visit - Established Patient, Low Complexity | $210 | 0% | $210 |
| Office Visit - Established Patient, Moderate Complexity | $301 | 0% | $301 |
| Office Visit - New Patient, Low Complexity | $305 | 0% | $305 |
| Office Visit - New Patient, Minor | $218 | 0% | $218 |
| Office Visit - New Patient, Moderate Complexity | $473 | 0% | $473 |
| Pap Test | $155 | 0% | $155 |
| Physical Therapy - Low Complexity Evaluation | $288 | 0% | $288 |
| Physical Therapy - Manual Therapy | $116 | 0% | $116 |
| Physical Therapy - Moderate Complexity Evaluation | $288 | 0% | $288 |
| Physical Therapy - Therapeutic Exercises | $126 | 0% | $126 |
| Strep Test (Streptococcus, group A) | $88 | 0% | $88 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $41 | 0% | $41 |
| Ultrasound - Abdominal, Complete | $769 | 0% | $769 |
| Ultrasound - Abdominal, Limited | $531 | 0% | $531 |
| Ultrasound - Breast (outpatient) | $1,298 | 0% | $1,298 |
| Ultrasound - Head and Neck | $517 | 0% | $517 |
| Ultrasound - Pregnancy Follow-Up | $852 | 0% | $852 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,392 | 0% | $5,392 |
| Urine Capacity Measurement | $445 | 0% | $445 |
| Urine Test - Automated with Microscope Examination | $21 | 0% | $21 |
| Urine Test - Automated without Microscope | $14 | 0% | $14 |
| Urine Test - Bacterial Culture | $48 | 0% | $48 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $50 | 0% | $50 |
| Urine Test - Chlamydia | $139 | 0% | $139 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $139 | 0% | $139 |
| Urine Test - Microalbumin (Protein) Level | $30 | 0% | $30 |
| Urine Test - Pregnancy | $43 | 0% | $43 |
| Urine Test - Urinalysis, Manual Test | $19 | 0% | $19 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $352 | 0% | $352 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $74 | 0% | $74 |
| X-Ray - Abdomen | $582 | 0% | $582 |
| X-Ray - Chest (outpatient) | $570 | 0% | $570 |
| X-Ray - Foot (outpatient) | $437 | 0% | $437 |
| X-Ray - Wrist (outpatient) | $474 | 0% | $474 |
