| Arthrocentesis (outpatient) | $1,161 | 0% | $1,161 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $55 | 0% | $55 |
| Blood Test - Cholesterol Test, Lipid Panel | $134 | 0% | $134 |
| Blood Test - Clotting Time | $28 | 0% | $28 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $33 | 0% | $33 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $70 | 0% | $70 |
| Blood Test - Comprehensive Metabolic Panel | $92 | 0% | $92 |
| Blood Test - Ferritin (Blood Protein) Level | $106 | 0% | $106 |
| Blood Test - General Health Panel | $213 | 0% | $213 |
| Blood Test - Hepatitis C Antibody Level | $181 | 0% | $181 |
| Blood Test - Iron Level | $56 | 0% | $56 |
| Blood Test - LDL Cholesterol Level | $99 | 0% | $99 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $148 | 0% | $148 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $109 | 0% | $109 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $120 | 0% | $120 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $206 | 0% | $206 |
| Blood Test - Vitamin D-3 Level | $287 | 0% | $287 |
| Destruction of Lesion (outpatient) | $572 | 0% | $572 |
| Detection test for Human Papillomavirus (HPV) | $195 | 0% | $195 |
| Electrocardiogram (ECG or EKG) | $551 | 0% | $551 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $195 | 0% | $195 |
| Lab Test - Detection test for Influenza Virus | $84 | 0% | $84 |
| Mammogram (outpatient) | $737 | 0% | $737 |
| Office Visit - Basic | $69 | 0% | $69 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $238 | 0% | $238 |
| 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 | $270 | 0% | $270 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $213 | 0% | $213 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $376 | 0% | $376 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $191 | 0% | $191 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $209 | 0% | $209 |
| 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 - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $190 | 0% | $190 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $289 | 0% | $289 |
| Office Visit - Established Patient, High Complexity | $252 | 0% | $252 |
| 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 |
| Office Visit - New Patient, Moderate Complexity | $400 | 0% | $400 |
| Pap Test | $246 | 0% | $246 |
| Strep Test (Streptococcus, group A) | $88 | 0% | $88 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $57 | 0% | $57 |
| Ultrasound - Pregnancy (outpatient) | $168 | 0% | $168 |
| Ultrasound - Transvaginal (non-maternity) | $1,962 | 0% | $1,962 |
| Urine Test - Automated with Microscope Examination | $44 | 0% | $44 |
| Urine Test - Automated without Microscope | $3 | 0% | $3 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $87 | 0% | $87 |
| Urine Test - Microalbumin (Protein) Level | $95 | 0% | $95 |
| Urine Test - Pregnancy | $106 | 0% | $106 |
| Urine Test - Urinalysis, Manual Test | $29 | 0% | $29 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $197 | 0% | $197 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $69 | 0% | $69 |
| X-Ray - Chest (outpatient) | $651 | 0% | $651 |
