| Bacterial Culture - Aerobic Isolates | $47 | 0% | $47 |
| Bacterial Culture - Swab | $100 | 0% | $100 |
| Blood Test - Basic Metabolic Panel | $103 | 0% | $103 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $103 | 0% | $103 |
| Blood Test - Cholesterol Test, Lipid Panel | $100 | 0% | $100 |
| Blood Test - Clotting Time | $49 | 0% | $49 |
| Blood Test - Coagulation Assessment | $70 | 0% | $70 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $81 | 0% | $81 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $93 | 0% | $93 |
| Blood Test - Comprehensive Metabolic Panel | $81 | 0% | $81 |
| Blood Test - Electrolytes Panel | $80 | 0% | $80 |
| Blood Test - Ferritin (Blood Protein) Level | $153 | 0% | $153 |
| Blood Test - Folic Acid Level | $60 | 0% | $60 |
| Blood Test - General Health Panel | $274 | 0% | $274 |
| Blood Test - Hepatic (Liver) Function Panel | $166 | 0% | $166 |
| Blood Test - Hepatitis C Antibody Level | $51 | 0% | $51 |
| Blood Test - Iron Level | $81 | 0% | $81 |
| Blood Test - Lipase (fat enzyme) Level | $71 | 0% | $71 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $100 | 0% | $100 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $114 | 0% | $114 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $47 | 0% | $47 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $62 | 0% | $62 |
| Blood Test - Vitamin D-3 Level | $128 | 0% | $128 |
| Colonoscopy - Diagnostic (outpatient) | $4,201 | 0% | $4,201 |
| Colonoscopy - With Polyp Removal (outpatient) | $5,377 | 0% | $5,377 |
| Detection test for Human Papillomavirus (HPV) | $107 | 0% | $107 |
| Emergency Department Visit - Low Complexity (outpatient) | $348 | 0% | $348 |
| Emergency Department Visit - Minor (outpatient) | $311 | 0% | $311 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $650 | 0% | $650 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $66 | 0% | $66 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $59 | 0% | $59 |
| Lab Test - Detection test for Influenza Virus | $45 | 0% | $45 |
| Lab Test - Smear for Microorganism | $74 | 0% | $74 |
| Mammogram (outpatient) | $639 | 0% | $639 |
| MRI - Brain (outpatient) | $3,296 | 0% | $3,296 |
| MRI - Knee (outpatient) | $1,851 | 0% | $1,851 |
| MRI - Shoulder, Elbow, or Wrist | $3,565 | 0% | $3,565 |
| Office Visit - Basic | $75 | 0% | $75 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $214 | 0% | $214 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $234 | 0% | $234 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $235 | 0% | $235 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $257 | 0% | $257 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $213 | 0% | $213 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $192 | 0% | $192 |
| Office Visit - Established Patient, High Complexity | $235 | 0% | $235 |
| Office Visit - Established Patient, Low Complexity | $119 | 0% | $119 |
| Office Visit - Established Patient, Moderate Complexity | $174 | 0% | $174 |
| Office Visit - New Patient, Low Complexity | $172 | 0% | $172 |
| Office Visit - New Patient, Minor | $164 | 0% | $164 |
| Pap Test | $125 | 0% | $125 |
| Physical Therapy - Low Complexity Evaluation | $170 | 0% | $170 |
| Physical Therapy - Manual Therapy | $90 | 0% | $90 |
| Physical Therapy - Moderate Complexity Evaluation | $259 | 0% | $259 |
| Physical Therapy - Therapeutic Exercises | $90 | 0% | $90 |
| Physical Therapy - Ultrasound Therapy | $79 | 0% | $79 |
| Psychiatric Diagnostic Evaluation | $204 | 0% | $204 |
| Psychotherapy - 30 Minutes | $84 | 0% | $84 |
| Psychotherapy - 45 Minutes | $114 | 0% | $114 |
| Psychotherapy - Group Session | $194 | 0% | $194 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $74 | 0% | $74 |
| Ultrasound - Abdominal, Limited | $1,075 | 0% | $1,075 |
| Ultrasound - Breast (outpatient) | $1,531 | 0% | $1,531 |
| Ultrasound - Head and Neck | $1,113 | 0% | $1,113 |
| Ultrasound - Pregnancy (outpatient) | $1,306 | 0% | $1,306 |
| Ultrasound - Transvaginal (non-maternity) | $1,407 | 0% | $1,407 |
| Urine Test - Automated without Microscope | $27 | 0% | $27 |
| Urine Test - Bacterial Culture | $53 | 0% | $53 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $40 | 0% | $40 |
| Urine Test - Chlamydia | $100 | 0% | $100 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $100 | 0% | $100 |
| Urine Test - Microalbumin (Protein) Level | $62 | 0% | $62 |
| Urine Test - Pregnancy | $72 | 0% | $72 |
| Urine Test - Urinalysis, Manual Test | $40 | 0% | $40 |
| X-Ray - Abdomen | $520 | 0% | $520 |
| X-Ray - Ankle (outpatient) | $440 | 0% | $440 |
| X-Ray - Chest (outpatient) | $816 | 0% | $816 |
| X-Ray - Foot (outpatient) | $676 | 0% | $676 |
| X-Ray - Hip | $468 | 0% | $468 |
| X-Ray - Knee (outpatient) | $667 | 0% | $667 |
| X-Ray - Shoulder (outpatient) | $563 | 0% | $563 |
| X-Ray - Spine (outpatient) | $940 | 0% | $940 |
| X-Ray - Wrist (outpatient) | $603 | 0% | $603 |
