| Bacterial Culture - Aerobic Isolates | $31 | 0% | $31 |
| Blood Test - Hepatitis C Antibody Level | $119 | 0% | $119 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $137 | 0% | $137 |
| Detection test for Human Papillomavirus (HPV) | $137 | 0% | $137 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $74 | 0% | $74 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $84 | 0% | $84 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $148 | 0% | $148 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $411 | 0% | $411 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $439 | 0% | $439 |
| Office Visit - Established Patient, High Complexity | $394 | 0% | $394 |
| Office Visit - Established Patient, Low Complexity | $218 | 0% | $218 |
| Office Visit - Established Patient, Moderate Complexity | $315 | 0% | $315 |
| Pap Test | $126 | 0% | $126 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $45 | 0% | $45 |
| Urine Test - Automated with Microscope Examination | $50 | 0% | $50 |
| Urine Test - Bacterial Culture | $31 | 0% | $31 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $64 | 0% | $64 |
| Urine Test - Chlamydia | $139 | 0% | $139 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $139 | 0% | $139 |
| Urine Test - Pregnancy | $43 | 0% | $43 |
