| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $69 | N/A | $69 |
| Blood Test - Blood Typing (ABO) | $46 | N/A | $46 |
| Blood Test - Blood Typing (Rh (D)) | $42 | N/A | $42 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $33 | N/A | $33 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | N/A | $33 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $109 | N/A | $109 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $193 | N/A | $193 |
| Mammogram (outpatient) | $840 | N/A | $840 |
| Office Visit - Basic | $79 | N/A | $79 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $347 | N/A | $347 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $368 | N/A | $368 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $294 | N/A | $294 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $305 | N/A | $305 |
| Office Visit - Established Patient, Low Complexity | $137 | N/A | $137 |
| Office Visit - Established Patient, Moderate Complexity | $210 | N/A | $210 |
| Pap Test, manual screening | $105 | N/A | $105 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $86 | N/A | $86 |
| Ultrasound - Pelvic (outpatient) | $263 | N/A | $263 |
| Ultrasound - Pregnancy (outpatient) | $341 | N/A | $341 |
| Ultrasound - Pregnancy Follow-Up | $236 | N/A | $236 |
| Ultrasound - Transvaginal (non-maternity) | $1,011 | N/A | $1,011 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $95 | N/A | $95 |
| Urine Test - Pregnancy | $12 | N/A | $12 |
| Urine Test - Urinalysis, Manual Test | $11 | N/A | $11 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $53 | N/A | $53 |
