| Bacterial Culture - Aerobic Isolates | $19 | N/A | $19 |
| Bacterial Culture - Swab | $27 | N/A | $27 |
| Blood Test - Basic Metabolic Panel | $24 | N/A | $24 |
| Blood Test - Blood Glucose (Sugar) Level | $15 | N/A | $15 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $30 | N/A | $30 |
| Blood Test - Blood Typing (ABO) | $5 | N/A | $5 |
| Blood Test - Blood Typing (Rh (D)) | $7 | N/A | $7 |
| Blood Test - C-reactive Protein (CRP) Level | $22 | N/A | $22 |
| Blood Test - Cholesterol Test, Lipid Panel | $41 | N/A | $41 |
| Blood Test - Clotting Time | $19 | N/A | $19 |
| Blood Test - Coagulation Assessment | $31 | N/A | $31 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $17 | N/A | $17 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $23 | N/A | $23 |
| Blood Test - Comprehensive Metabolic Panel | $27 | N/A | $27 |
| Blood Test - Creatinine Level | $17 | N/A | $17 |
| Blood Test - Electrolytes Panel | $28 | N/A | $28 |
| Blood Test - Ferritin (Blood Protein) Level | $59 | N/A | $59 |
| Blood Test - Folic Acid Level | $32 | N/A | $32 |
| Blood Test - General Health Panel | $110 | N/A | $110 |
| Blood Test - Hepatic (Liver) Function Panel | $23 | N/A | $23 |
| Blood Test - Hepatitis B Surface Antibody Level | $37 | N/A | $37 |
| Blood Test - Hepatitis C Antibody Level | $52 | N/A | $52 |
| Blood Test - Iron Binding Capacity | $20 | N/A | $20 |
| Blood Test - Iron Level | $15 | N/A | $15 |
| Blood Test - LDL Cholesterol Level | $56 | N/A | $56 |
| Blood Test - Lead Level | $39 | N/A | $39 |
| Blood Test - Lipase (fat enzyme) Level | $21 | N/A | $21 |
| Blood Test - Magnesium Level | $16 | N/A | $16 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $49 | N/A | $49 |
| Blood Test - Renal (Kidney) Function Panel | $27 | N/A | $27 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $55 | N/A | $55 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $60 | N/A | $60 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $36 | N/A | $36 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $81 | N/A | $81 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $39 | N/A | $39 |
| Blood Test - Vitamin D-3 Level | $108 | N/A | $108 |
| Electrocardiogram (ECG or EKG), Tracing | $483 | N/A | $483 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $72 | N/A | $72 |
| Lab Test - Creatinine Level | $18 | N/A | $18 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $48 | N/A | $48 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $32 | N/A | $32 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $25 | N/A | $25 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $76 | N/A | $76 |
| Lab Test - Detection test for Influenza Virus | $35 | N/A | $35 |
| Lab Test - Smear for Microorganism | $8 | N/A | $8 |
| Office Visit - Basic | $77 | N/A | $77 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $228 | N/A | $228 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $193 | N/A | $193 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $210 | N/A | $210 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $210 | N/A | $210 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $248 | N/A | $248 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $229 | N/A | $229 |
| Office Visit - Established Patient, High Complexity | $223 | N/A | $223 |
| Office Visit - Established Patient, Low Complexity | $147 | N/A | $147 |
| Office Visit - Established Patient, Moderate Complexity | $183 | N/A | $183 |
| Office Visit - New Patient, Low Complexity | $200 | N/A | $200 |
| Office Visit - New Patient, Minor | $147 | N/A | $147 |
| Office Visit - New Patient, Moderate Complexity | $340 | N/A | $340 |
| Pap Test, automated screening and manual rescreening | $126 | N/A | $126 |
| Pap Test, manual screening | $39 | N/A | $39 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $28 | N/A | $28 |
| Urine Test - Automated with Microscope Examination | $13 | N/A | $13 |
| Urine Test - Automated without Microscope | $11 | N/A | $11 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $41 | N/A | $41 |
| Urine Test - Chlamydia | $57 | N/A | $57 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $57 | N/A | $57 |
| Urine Test - Microalbumin (Protein) Level | $31 | N/A | $31 |
| Urine Test - Pregnancy | $89 | N/A | $89 |
| Urine Test - Urinalysis, Manual Test | $12 | N/A | $12 |
| Vaccine - Influenza for Injection into Muscle | $24 | N/A | $24 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $51 | N/A | $51 |
