| Blood Test - Blood Glucose (Sugar) Level | $43 | N/A | $43 |
| Blood Test - Cholesterol Test, Lipid Panel | $107 | N/A | $107 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | N/A | $151 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | N/A | $81 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $155 | N/A | $155 |
| Mammogram (outpatient) | $1,068 | N/A | $1,068 |
| Office Visit - Basic | $168 | N/A | $168 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $310 | N/A | $310 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $387 | N/A | $387 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $422 | N/A | $422 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $461 | N/A | $461 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $310 | N/A | $310 |
| Office Visit - Established Patient, Low Complexity | $235 | N/A | $235 |
| Office Visit - Established Patient, Moderate Complexity | $358 | N/A | $358 |
| Urine Test - Automated without Microscope | $27 | N/A | $27 |
| Urine Test - Urinalysis, Manual Test | $57 | N/A | $57 |
| Vaccine - Influenza for Injection into Muscle | $62 | N/A | $62 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $143 | N/A | $143 |
