| Services/Procedure |
|
| Limited-New99202 |
|
| Intermediate-New99203 |
|
| Comprehensive-New99204 |
|
| Preventive 12-17 New99384 |
|
| Preventive 18-39 New99385 |
|
| Minimal-Established99211 |
|
| Limited-Established99212 |
|
| Intermediate-Established99213 |
|
| Comprehensive-Established99214 |
|
| Preventive 12-17 Established99394 |
|
| Preventive 18-39 Established99395 |
|
| Preventive 40-64 Established99396 |
|
| Procedure |
|
| IUD Insertion58300 |
|
| IUD Removal58301 |
|
| Female Genital Wart Treatment56501 |
|
| Male Genital Wart Treatment54050 |
|
| Injection Fee96372 |
|
| Implant Insertion11981 |
|
| Implant Removal11982 |
|
| Implant Insertion/Removal11983 |
|
| Vasectomy55250 |
|
| Venipuncture36415 |
|
| Labs |
|
| Chlamydia87491 |
|
| Gonorrhea87591 |
|
| HerpesViralCulture87254 |
|
| Syphilis-TPPA86593 |
|
| RPRQualitative86592 |
|
| HIVRapid86703 |
|
| HIVSerum87389 |
|
| HPVTest87624 |
|
| PapConventional88164 |
|
| Pap Liquid Base88142 |
|
| Pathology Interpretation88141 |
|
| UrinePregnancyTest81025 |
|
| UADipstick81002 |
|
| UA Dip Automated81003 |
|
| WetMount/GramStain87210 |
|
| Supplies |
|
| Basal ThermometerA4931 |
|
| DepoProveraJ1050 |
|
| MedroxyProgesteroneJ1050 |
|
| VCF FoamA4269 |
|
| Gynol IIA4269 |
|
| LilettaIUDJ7297 |
|
| ParagardIUDJ7300 |
|
| MirenaIUDJ7300 |
|
| XulaneJ7304 |
|
| NuvaRingJ7303 |
|
| NexplanonJ7307 |
|
| AleseS4993 |
|
| ApriS4993 |
|
| AubraS4993 |
|
| AvianeS4993 |
|
| BicillinS4993 |
|
| CamilaS4993 |
|
| CeftriaxoneJ0696 |
|
| ChatealS4993 |
|
| CryselleS4993 | |
| CyredS4993 | |
| DoxycyclineS4993 | |
| EnpresseS4993 | |
| JolivetteS4993 | |
| LevoraS4993 | |
| LuteraS4993 | |
| LyzaS4993 | |
| MononessaS4993 | |
| Nor QDS4993 | |
| NordetteS4993 | |
| NorethindroneS4993 | |
| Nortrel 777S4993 | |
| OrsythiaS4993 | |
| PortiaS4993 | |
| ReclipsenS4993 | |
| SprintecS4993 | |
| SronyxS4993 | |
| Tri-LoMarziaS4993 | |
| Tri-Lo SprintecS4993 | |
| TriNessa LoS4993 | |
| TriphasilS4993 | |
| TrivoraS4993 | |
| VilbraS4993 | |
Receipt
Total
$0.00