| Blood Test - Blood Typing (ABO) | $44 | N/A | $44 |
| Blood Test - Blood Typing (Rh (D)) | $44 | N/A | $44 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $33 | N/A | $33 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $107 | N/A | $107 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $158 | N/A | $158 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $166 | N/A | $166 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $103 | N/A | $103 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $168 | N/A | $168 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $249 | N/A | $249 |
| Office Visit - Basic | $142 | N/A | $142 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $404 | N/A | $404 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $462 | N/A | $462 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $362 | N/A | $362 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $383 | N/A | $383 |
| Office Visit - Established Patient, High Complexity | $420 | N/A | $420 |
| Office Visit - Established Patient, Low Complexity | $211 | N/A | $211 |
| Office Visit - Established Patient, Moderate Complexity | $312 | N/A | $312 |
| Ultrasound - Pelvic (outpatient) | $466 | N/A | $466 |
| Ultrasound - Pregnancy (outpatient) | $461 | N/A | $461 |
| Ultrasound - Pregnancy Follow-Up | $341 | N/A | $341 |
| Ultrasound - Transvaginal (non-maternity) | $572 | N/A | $572 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $76 | N/A | $76 |
| Urine Test - Pregnancy | $28 | N/A | $28 |
| Urine Test - Urinalysis, Manual Test | $16 | N/A | $16 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $80 | N/A | $80 |
