| Bacterial Culture - Aerobic Isolates | $35 | 0% | $35 |
| Bacterial Culture - Swab | $37 | 0% | $37 |
| Blood Test - Basic Metabolic Panel | $36 | 0% | $36 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $41 | 0% | $41 |
| Blood Test - Cholesterol Test, Lipid Panel | $70 | 0% | $70 |
| Blood Test - Clotting Time | $17 | 0% | $17 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $27 | 0% | $27 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | 0% | $33 |
| Blood Test - Comprehensive Metabolic Panel | $45 | 0% | $45 |
| Blood Test - Electrolytes Panel | $29 | 0% | $29 |
| Blood Test - Ferritin (Blood Protein) Level | $58 | 0% | $58 |
| Blood Test - Folic Acid Level | $62 | 0% | $62 |
| Blood Test - General Health Panel | $127 | 0% | $127 |
| Blood Test - Hepatic (Liver) Function Panel | $35 | 0% | $35 |
| Blood Test - Hepatitis C Antibody Level | $61 | 0% | $61 |
| Blood Test - Iron Level | $27 | 0% | $27 |
| Blood Test - LDL Cholesterol Level | $41 | 0% | $41 |
| Blood Test - Lipase (fat enzyme) Level | $29 | 0% | $29 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $78 | 0% | $78 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $71 | 0% | $71 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $38 | 0% | $38 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $64 | 0% | $64 |
| Blood Test - Vitamin D-3 Level | $125 | 0% | $125 |
| Destruction of Lesion (outpatient) | $542 | 0% | $542 |
| Destruction of Lesions, up to 14 | $522 | 0% | $522 |
| Detection test for Human Papillomavirus (HPV) | $93 | 0% | $93 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $37 | 0% | $37 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $44 | 0% | $44 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $104 | 0% | $104 |
| Lab Test - Smear for Microorganism | $18 | 0% | $18 |
| Office Visit - Basic | $128 | 0% | $128 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $408 | 0% | $408 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $427 | 0% | $427 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $368 | 0% | $368 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $392 | 0% | $392 |
| Office Visit - Established Patient, High Complexity | $418 | 0% | $418 |
| Office Visit - Established Patient, Low Complexity | $212 | 0% | $212 |
| Office Visit - Established Patient, Moderate Complexity | $312 | 0% | $312 |
| Office Visit - New Patient, Low Complexity | $312 | 0% | $312 |
| Office Visit - New Patient, Minor | $217 | 0% | $217 |
| Pap Test | $111 | 0% | $111 |
| Psychiatric Diagnostic Evaluation | $158 | 0% | $158 |
| Psychotherapy - 45 Minutes | $126 | 0% | $126 |
| Psychotherapy - 60 Minutes | $147 | 0% | $147 |
| Psychotherapy - Family Session | $147 | 0% | $147 |
| Strep Test (Streptococcus, group A) | $51 | 0% | $51 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $28 | 0% | $28 |
| Urine Test - Automated without Microscope | $9 | 0% | $9 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $35 | 0% | $35 |
| Urine Test - Chlamydia | $148 | 0% | $148 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $148 | 0% | $148 |
| Urine Test - Microalbumin (Protein) Level | $24 | 0% | $24 |
| Urine Test - Pregnancy | $27 | 0% | $27 |
| Urine Test - Urinalysis, Manual Test | $11 | 0% | $11 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $498 | 0% | $498 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $102 | 0% | $102 |
