| Arthrocentesis (outpatient) | $373 | 0% | $373 |
| Blood Test - Basic Metabolic Panel | $74 | 0% | $74 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $28 | 0% | $28 |
| Blood Test - Comprehensive Metabolic Panel | $92 | 0% | $92 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $137 | 0% | $137 |
| Destruction of Lesion (outpatient) | $375 | 0% | $375 |
| Detection test for Human Papillomavirus (HPV) | $137 | 0% | $137 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $114 | 0% | $114 |
| Office Visit - Basic | $97 | 0% | $97 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $323 | 0% | $323 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $327 | 0% | $327 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $369 | 0% | $369 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $289 | 0% | $289 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $259 | 0% | $259 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $264 | 0% | $264 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $284 | 0% | $284 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $284 | 0% | $284 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $301 | 0% | $301 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $253 | 0% | $253 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $242 | 0% | $242 |
| Office Visit - Established Patient, High Complexity | $316 | 0% | $316 |
| Office Visit - Established Patient, Low Complexity | $162 | 0% | $162 |
| Office Visit - Established Patient, Moderate Complexity | $236 | 0% | $236 |
| Office Visit - New Patient, Low Complexity | $235 | 0% | $235 |
| Office Visit - New Patient, Minor | $163 | 0% | $163 |
| Office Visit - New Patient, Moderate Complexity | $356 | 0% | $356 |
| Pap Test | $126 | 0% | $126 |
| Psychiatric Diagnostic Evaluation | $184 | 0% | $184 |
| Psychotherapy - 30 Minutes | $139 | 0% | $139 |
| Psychotherapy - 60 Minutes | $158 | 0% | $158 |
| Psychotherapy - Family Session | $210 | 0% | $210 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Urine Test - Automated without Microscope | $53 | 0% | $53 |
| Urine Test - Pregnancy | $17 | 0% | $17 |
| Urine Test - Urinalysis, Manual Test | $13 | 0% | $13 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $68 | 0% | $68 |
