| Blood Test - Hepatitis B Surface Antibody Level | $40 | N/A | $40 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $93 | N/A | $93 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $40 | N/A | $40 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $53 | N/A | $53 |
| Lab Test - Detection test for Influenza Virus | $42 | N/A | $42 |
| Office Visit - Basic | $76 | N/A | $76 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $197 | N/A | $197 |
| Office Visit - Established Patient, Low Complexity | $117 | N/A | $117 |
| Office Visit - New Patient, Low Complexity | $195 | N/A | $195 |
| Office Visit - New Patient, Minor | $128 | N/A | $128 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $49 | N/A | $49 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $57 | N/A | $57 |
| Urine Test - Chlamydia | $106 | N/A | $106 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $111 | N/A | $111 |
| Urine Test - Pregnancy | $29 | N/A | $29 |
| Urine Test - Urinalysis, Manual Test | $15 | N/A | $15 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $68 | N/A | $68 |
