| Arthrocentesis (outpatient) | $216 | 0% | $216 |
| Bacterial Culture - Swab | $27 | 0% | $27 |
| Blood Test - Basic Metabolic Panel | $28 | 0% | $28 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $33 | 0% | $33 |
| Blood Test - Cholesterol Test, Lipid Panel | $60 | 0% | $60 |
| Blood Test - Clotting Time | $49 | 0% | $49 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $22 | 0% | $22 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $26 | 0% | $26 |
| Blood Test - Comprehensive Metabolic Panel | $35 | 0% | $35 |
| Blood Test - Ferritin (Blood Protein) Level | $45 | 0% | $45 |
| Blood Test - Folic Acid Level | $49 | 0% | $49 |
| Blood Test - General Health Panel | $104 | 0% | $104 |
| Blood Test - Hepatitis C Antibody Level | $152 | 0% | $152 |
| Blood Test - Iron Level | $22 | 0% | $22 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $61 | 0% | $61 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $56 | 0% | $56 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $29 | 0% | $29 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $49 | 0% | $49 |
| Blood Test - Vitamin D-3 Level | $99 | 0% | $99 |
| Electrocardiogram (ECG or EKG) | $313 | 0% | $313 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $89 | 0% | $89 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $114 | 0% | $114 |
| Lab Test - Detection test for Influenza Virus | $50 | 0% | $50 |
| Mammogram (outpatient) | $837 | 0% | $837 |
| Office Visit - Basic | $118 | 0% | $118 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $292 | 0% | $292 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $359 | 0% | $359 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $318 | 0% | $318 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $402 | 0% | $402 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $318 | 0% | $318 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $294 | 0% | $294 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | 0% | $281 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $306 | 0% | $306 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $312 | 0% | $312 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $333 | 0% | $333 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $280 | 0% | $280 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $264 | 0% | $264 |
| Office Visit - Established Patient, High Complexity | $314 | 0% | $314 |
| Office Visit - Established Patient, Low Complexity | $194 | 0% | $194 |
| Office Visit - Established Patient, Moderate Complexity | $286 | 0% | $286 |
| Office Visit - New Patient, Low Complexity | $289 | 0% | $289 |
| Office Visit - New Patient, Minor | $200 | 0% | $200 |
| Office Visit - New Patient, Moderate Complexity | $408 | 0% | $408 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Urine Test - Automated with Microscope Examination | $11 | 0% | $11 |
| Urine Test - Automated without Microscope | $7 | 0% | $7 |
| Urine Test - Bacterial Culture | $67 | 0% | $67 |
| Urine Test - Chlamydia | $117 | 0% | $117 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $117 | 0% | $117 |
| Urine Test - Microalbumin (Protein) Level | $19 | 0% | $19 |
| Urine Test - Pregnancy | $23 | 0% | $23 |
| Urine Test - Urinalysis, Manual Test | $9 | 0% | $9 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $439 | 0% | $439 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $95 | 0% | $95 |
