| Blood Test - Blood Glucose (Sugar) Level | $51 | N/A | $51 |
| 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) | $73 | N/A | $73 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $107 | N/A | $107 |
| Blood Test - Creatinine Level | $66 | N/A | $66 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $218 | N/A | $218 |
| Lab Test - Creatinine Level | $73 | N/A | $73 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $249 | N/A | $249 |
| Mammogram (outpatient) | $951 | N/A | $951 |
| Office Visit - Basic | $116 | N/A | $116 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $336 | N/A | $336 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $394 | N/A | $394 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $310 | N/A | $310 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $326 | N/A | $326 |
| Office Visit - Established Patient, High Complexity | $383 | N/A | $383 |
| Office Visit - Established Patient, Low Complexity | $189 | N/A | $189 |
| Office Visit - Established Patient, Moderate Complexity | $278 | N/A | $278 |
| Office Visit - New Patient, Low Complexity | $289 | N/A | $289 |
| Office Visit - New Patient, Minor | $194 | N/A | $194 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $53 | N/A | $53 |
| Ultrasound - Pelvic (outpatient) | $326 | N/A | $326 |
| Ultrasound - Pregnancy (outpatient) | $399 | N/A | $399 |
| Ultrasound - Pregnancy Follow-Up | $315 | N/A | $315 |
| Ultrasound - Transvaginal (non-maternity) | $336 | N/A | $336 |
| Urine Test - Automated without Microscope | $7 | N/A | $7 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $64 | N/A | $64 |
| Urine Test - Chlamydia | $95 | N/A | $95 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $95 | N/A | $95 |
| Urine Test - Pregnancy | $23 | N/A | $23 |
| Urine Test - Urinalysis, Manual Test | $14 | N/A | $14 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $84 | N/A | $84 |
