| Bacterial Culture - Aerobic Isolates | $31 | N/A | $31 |
| Blood Test - Hepatitis C Antibody Level | $132 | N/A | $132 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $137 | N/A | $137 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $74 | N/A | $74 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $83 | N/A | $83 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $114 | N/A | $114 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $137 | N/A | $137 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $411 | N/A | $411 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $439 | N/A | $439 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $267 | N/A | $267 |
| Office Visit - Established Patient, High Complexity | $394 | N/A | $394 |
| Office Visit - Established Patient, Low Complexity | $218 | N/A | $218 |
| Office Visit - Established Patient, Moderate Complexity | $315 | N/A | $315 |
| Pap Test, automated screening and manual rescreening | $126 | N/A | $126 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $45 | N/A | $45 |
| Urine Test - Automated with Microscope Examination | $50 | N/A | $50 |
| Urine Test - Bacterial Culture | $31 | N/A | $31 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $64 | N/A | $64 |
| Urine Test - Chlamydia | $139 | N/A | $139 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $139 | N/A | $139 |
| Urine Test - Pregnancy | $43 | N/A | $43 |
