| Bacterial Culture - Aerobic Isolates | $38 | N/A | $38 |
| Blood Test - Basic Metabolic Panel | $79 | N/A | $79 |
| Blood Test - Blood Glucose (Sugar) Level | $21 | N/A | $21 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $32 | N/A | $32 |
| Blood Test - Cholesterol Test, Lipid Panel | $53 | N/A | $53 |
| Blood Test - Clotting Time | $26 | N/A | $26 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $32 | N/A | $32 |
| Blood Test - Comprehensive Metabolic Panel | $105 | N/A | $105 |
| Blood Test - Creatinine Level | $21 | N/A | $21 |
| Blood Test - Electrolytes Panel | $32 | N/A | $32 |
| Blood Test - Ferritin (Blood Protein) Level | $47 | N/A | $47 |
| Blood Test - Folic Acid Level | $42 | N/A | $42 |
| Blood Test - General Health Panel | $221 | N/A | $221 |
| Blood Test - Hepatic (Liver) Function Panel | $74 | N/A | $74 |
| Blood Test - Iron Binding Capacity | $26 | N/A | $26 |
| Blood Test - Iron Level | $26 | N/A | $26 |
| Blood Test - Lipase (fat enzyme) Level | $69 | N/A | $69 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $58 | N/A | $58 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $53 | N/A | $53 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $154 | N/A | $154 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $237 | N/A | $237 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $47 | N/A | $47 |
| Blood Test - Vitamin D-3 Level | $89 | N/A | $89 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $788 | N/A | $788 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $74 | N/A | $74 |
| Lab Test - Creatinine Level | $21 | N/A | $21 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $61 | N/A | $61 |
| Lab Test - Detection test for Influenza Virus | $75 | N/A | $75 |
| Office Visit - Basic | $131 | N/A | $131 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $289 | N/A | $289 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $310 | N/A | $310 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $341 | N/A | $341 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $289 | N/A | $289 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $341 | N/A | $341 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $394 | N/A | $394 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $263 | N/A | $263 |
| Office Visit - Established Patient, High Complexity | $326 | N/A | $326 |
| Office Visit - Established Patient, Low Complexity | $194 | N/A | $194 |
| Office Visit - Established Patient, Moderate Complexity | $289 | N/A | $289 |
| Office Visit - New Patient, Low Complexity | $289 | N/A | $289 |
| Office Visit - New Patient, Minor | $210 | N/A | $210 |
| Office Visit - New Patient, Moderate Complexity | $341 | N/A | $341 |
| Pap Test, automated screening and manual rescreening | $126 | N/A | $126 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $25 | N/A | $25 |
| Urine Test - Automated without Microscope | $16 | N/A | $16 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $26 | N/A | $26 |
| Urine Test - Chlamydia | $105 | N/A | $105 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $105 | N/A | $105 |
| Urine Test - Pregnancy | $53 | N/A | $53 |
| Urine Test - Urinalysis, Manual Test | $53 | N/A | $53 |
| Vaccine - Influenza for Injection into Muscle | $53 | N/A | $53 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $368 | N/A | $368 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $131 | N/A | $131 |
