| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $69 | 0% | $69 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $33 | 0% | $33 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | 0% | $33 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $109 | 0% | $109 |
| Detection test for Human Papillomavirus (HPV) | $193 | 0% | $193 |
| Mammogram (outpatient) | $824 | 0% | $824 |
| Office Visit - Basic | $79 | 0% | $79 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $399 | 0% | $399 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $446 | 0% | $446 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $315 | 0% | $315 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $341 | 0% | $341 |
| Office Visit - Established Patient, High Complexity | $252 | 0% | $252 |
| Office Visit - Established Patient, Low Complexity | $137 | 0% | $137 |
| Office Visit - Established Patient, Moderate Complexity | $210 | 0% | $210 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $86 | 0% | $86 |
| Ultrasound - Pelvic (outpatient) | $263 | 0% | $263 |
| Ultrasound - Pregnancy (outpatient) | $341 | 0% | $341 |
| Ultrasound - Pregnancy Follow-Up | $404 | 0% | $404 |
| Ultrasound - Transvaginal (non-maternity) | $389 | 0% | $389 |
| Urine Test - Pregnancy | $12 | 0% | $12 |
| Urine Test - Urinalysis, Manual Test | $11 | 0% | $11 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $47 | 0% | $47 |
