| Bacterial Culture Swab | $65 | 0% | $65 | 
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $48 | 0% | $48 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $137 | 0% | $137 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $137 | 0% | $137 |
Medium |
| Mammogram (outpatient) | $949 | 0% | $949 |
Medium |
| Office Visit - Basic | $84 | 0% | $84 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $252 | 0% | $252 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $284 | 0% | $284 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $231 | 0% | $231 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $242 | 0% | $242 |
Medium |
| Office Visit - Established Patient, High Complexity | $284 | 0% | $284 |
Medium |
| Office Visit - Established Patient, Low Complexity | $137 | 0% | $137 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $200 | 0% | $200 |
Medium |
| Pap Test | $164 | 0% | $164 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $78 | 0% | $78 |
Medium |
| Ultrasound - Pelvic (outpatient) | $420 | 0% | $420 | 
High |
| Ultrasound - Pregnancy (outpatient) | $389 | 0% | $389 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $355 | 0% | $355 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $452 | 0% | $452 |
Medium |
| Urine Test - Chlamydia | $119 | 0% | $119 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $119 | 0% | $119 |
Medium |
| Urine Test - Pregnancy | $22 | 0% | $22 |
Medium |
