| Arthrocentesis (outpatient) | $1,615 | 0% | $1,615 |
| Blood Test - Cholesterol Test, Lipid Panel | $154 | 0% | $154 |
| Blood Test - Clotting Time | $7 | 0% | $7 |
| Blood Test - Comprehensive Metabolic Panel | $119 | 0% | $119 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $141 | 0% | $141 |
| Lab Test - Detection test for Influenza Virus | $84 | 0% | $84 |
| Office Visit - Basic | $69 | 0% | $69 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | 0% | $232 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $377 | 0% | $377 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $213 | 0% | $213 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $227 | 0% | $227 |
| Office Visit - Established Patient, Low Complexity | $186 | 0% | $186 |
| Office Visit - Established Patient, Moderate Complexity | $219 | 0% | $219 |
| Office Visit - New Patient, Low Complexity | $300 | 0% | $300 |
| Office Visit - New Patient, Minor | $230 | 0% | $230 |
| Strep Test (Streptococcus, group A) | $88 | 0% | $88 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $60 | 0% | $60 |
| Urine Test - Urinalysis, Manual Test | $29 | 0% | $29 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $188 | 0% | $188 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $69 | 0% | $69 |
