Bill	Diagnosis code(s)		Procedure code(s)		Charge
Medicare	V76.2	Special screening for malignant neoplasms; cervix	G0101	Pelvic exam and clinical breast check	$36.60
			Q0091	Collection of Pap smear specimen	$37.70
	401.1	Hypertension, benign	99213-25*	Office visit	$53.00
		Total amount billed and received		$127.30