| Blood Test - Clotting Time | $62 | 0% | $62 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $69 | 0% | $69 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $173 | 0% | $173 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $106 | 0% | $106 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $159 | 0% | $159 |
| Office Visit - Basic | $162 | 0% | $162 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $310 | 0% | $310 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $379 | 0% | $379 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $422 | 0% | $422 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $440 | 0% | $440 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $310 | 0% | $310 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $289 | 0% | $289 |
| Office Visit - Established Patient, Low Complexity | $226 | 0% | $226 |
| Office Visit - Established Patient, Moderate Complexity | $344 | 0% | $344 |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
| Urine Test - Urinalysis, Manual Test | $55 | 0% | $55 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $141 | 0% | $141 |
