| Blood Test - Complete Blood Cell Count and Automated WBC | $52 | 0% | $52 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $50 | 0% | $50 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $27 | 0% | $27 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $51 | 0% | $51 |
| Blood Test - Vitamin D-3 Level | $89 | 0% | $89 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $41 | 0% | $41 |
| Office Visit - Basic | $96 | 0% | $96 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $292 | 0% | $292 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $337 | 0% | $337 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $262 | 0% | $262 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $279 | 0% | $279 |
| Office Visit - Established Patient, High Complexity | $318 | 0% | $318 |
| Office Visit - Established Patient, Low Complexity | $161 | 0% | $161 |
| Office Visit - Established Patient, Moderate Complexity | $238 | 0% | $238 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $85 | 0% | $85 |
| Ultrasound - Pregnancy (outpatient) | $216 | 0% | $216 |
| Ultrasound - Pregnancy Follow-Up | $260 | 0% | $260 |
| Ultrasound - Transvaginal (non-maternity) | $519 | 0% | $519 |
| Urine Test - Automated with Microscope Examination | $10 | 0% | $10 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $85 | 0% | $85 |
| Urine Test - Chlamydia | $105 | 0% | $105 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $105 | 0% | $105 |
| Urine Test - Pregnancy | $19 | 0% | $19 |
| Urine Test - Urinalysis, Manual Test | $8 | 0% | $8 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $78 | 0% | $78 |
