| Bacterial Culture - Swab | $68 | N/A | $68 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $47 | N/A | $47 |
| Blood Test - Cholesterol Test, Lipid Panel | $173 | N/A | $173 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $89 | N/A | $89 |
| Blood Test - Comprehensive Metabolic Panel | $137 | N/A | $137 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $218 | N/A | $218 |
| Developmental Screening | $45 | N/A | $45 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $53 | N/A | $53 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $249 | N/A | $249 |
| Lab Test - Detection test for Influenza Virus | $54 | N/A | $54 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $297 | N/A | $297 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $296 | N/A | $296 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $317 | N/A | $317 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $339 | N/A | $339 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $302 | N/A | $302 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $254 | N/A | $254 |
| Office Visit - Established Patient, Low Complexity | $226 | N/A | $226 |
| Office Visit - Established Patient, Moderate Complexity | $324 | N/A | $324 |
| Office Visit - New Patient, Low Complexity | $303 | N/A | $303 |
| Office Visit - New Patient, Moderate Complexity | $420 | N/A | $420 |
| Urine Test - Automated without Microscope | $7 | N/A | $7 |
| Urine Test - Pregnancy | $27 | N/A | $27 |
| Urine Test - Urinalysis, Manual Test | $25 | N/A | $25 |
| Vaccine - Influenza for Injection into Muscle | $25 | N/A | $25 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $96 | N/A | $96 |
