| Mammogram (outpatient) | $942 | 0% | $942 | 
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 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $99 | 0% | $99 |
Medium |
| Ultrasound - Pelvic (outpatient) | $410 | 0% | $410 | 
High |
| Ultrasound - Pregnancy (outpatient) | $389 | 0% | $389 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $289 | 0% | $289 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $452 | 0% | $452 |
Medium |
| Urine Test - Chlamydia | $129 | 0% | $129 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $129 | 0% | $129 |
Medium |
| Urine Test - Pregnancy | $22 | 0% | $22 |
Medium |
