| Bacterial Culture - Aerobic Isolates | $19 | 0% | $19 |
| Bacterial Culture - Swab | $101 | 0% | $101 |
| Blood Test - Basic Metabolic Panel | $135 | 0% | $135 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $64 | 0% | $64 |
| Blood Test - Cholesterol Test, Lipid Panel | $47 | 0% | $47 |
| Blood Test - Clotting Time | $66 | 0% | $66 |
| Blood Test - Coagulation Assessment | $97 | 0% | $97 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $105 | 0% | $105 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $25 | 0% | $25 |
| Blood Test - Comprehensive Metabolic Panel | $168 | 0% | $168 |
| Blood Test - Ferritin (Blood Protein) Level | $102 | 0% | $102 |
| Blood Test - General Health Panel | $175 | 0% | $175 |
| Blood Test - Hepatic (Liver) Function Panel | $147 | 0% | $147 |
| Blood Test - Hepatitis C Antibody Level | $30 | 0% | $30 |
| Blood Test - Iron Level | $36 | 0% | $36 |
| Blood Test - LDL Cholesterol Level | $84 | 0% | $84 |
| Blood Test - Lipase (fat enzyme) Level | $77 | 0% | $77 |
| Blood Test - Pregnancy (Obstetric) Panel | $504 | 0% | $504 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $61 | 0% | $61 |
| Blood Test - Renal (Kidney) Function Panel | $141 | 0% | $141 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $61 | 0% | $61 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $140 | 0% | $140 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $111 | 0% | $111 |
| Blood Test - Vitamin D-3 Level | $100 | 0% | $100 |
| Detection test for Human Papillomavirus (HPV) | $152 | 0% | $152 |
| Emergency Department Visit - Low Complexity (outpatient) | $376 | 0% | $376 |
| Emergency Department Visit - Minor (outpatient) | $376 | 0% | $376 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $673 | 0% | $673 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $140 | 0% | $140 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $29 | 0% | $29 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $34 | 0% | $34 |
| Lab Test - Smear for Microorganism | $72 | 0% | $72 |
| Mammogram (outpatient) | $1,402 | 0% | $1,402 |
| Physical Therapy - Low Complexity Evaluation | $139 | 0% | $139 |
| Physical Therapy - Manual Therapy | $104 | 0% | $104 |
| Physical Therapy - Moderate Complexity Evaluation | $291 | 0% | $291 |
| Physical Therapy - Neuromuscular Reeducation | $104 | 0% | $104 |
| Physical Therapy - Therapeutic Exercises | $55 | 0% | $55 |
| Physical Therapy - Ultrasound Therapy | $27 | 0% | $27 |
| Strep Test (Streptococcus, group A) | $84 | 0% | $84 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $46 | 0% | $46 |
| Urine Test - Automated without Microscope | $32 | 0% | $32 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $32 | 0% | $32 |
| Urine Test - Chlamydia | $70 | 0% | $70 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $70 | 0% | $70 |
| Urine Test - Microalbumin (Protein) Level | $21 | 0% | $21 |
| Urine Test - Pregnancy | $53 | 0% | $53 |
| X-Ray - Chest (outpatient) | $856 | 0% | $856 |
| X-Ray - Hand | $581 | 0% | $581 |
| X-Ray - Knee (outpatient) | $695 | 0% | $695 |
| X-Ray - Shoulder (outpatient) | $801 | 0% | $801 |
