| Blood Test - Complete Blood Cell Count (Hemoglobin) | $89 | 0% | $89 |
| Mammogram (outpatient) | $951 | 0% | $951 |
| Office Visit - Basic | $116 | 0% | $116 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $336 | 0% | $336 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $394 | 0% | $394 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $289 | 0% | $289 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $310 | 0% | $310 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $326 | 0% | $326 |
| Office Visit - Established Patient, High Complexity | $362 | 0% | $362 |
| Office Visit - Established Patient, Low Complexity | $189 | 0% | $189 |
| Office Visit - Established Patient, Moderate Complexity | $278 | 0% | $278 |
| Office Visit - New Patient, Low Complexity | $273 | 0% | $273 |
| Office Visit - New Patient, Minor | $194 | 0% | $194 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $53 | 0% | $53 |
| Ultrasound - Pregnancy (outpatient) | $378 | 0% | $378 |
| Ultrasound - Pregnancy Follow-Up | $332 | 0% | $332 |
| Ultrasound - Transvaginal (non-maternity) | $336 | 0% | $336 |
| Urine Test - Automated without Microscope | $7 | 0% | $7 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $64 | 0% | $64 |
| Urine Test - Chlamydia | $95 | 0% | $95 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $95 | 0% | $95 |
| Urine Test - Pregnancy | $23 | 0% | $23 |
| Urine Test - Urinalysis, Manual Test | $14 | 0% | $14 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $84 | 0% | $84 |
