| Blood Test - Basic Metabolic Panel | $93 | N/A | $93 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $67 | N/A | $67 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $95 | N/A | $95 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $137 | N/A | $137 |
| Mammogram (outpatient) | $1,198 | N/A | $1,198 |
| Office Visit - Basic | $80 | N/A | $80 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $289 | N/A | $289 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $321 | N/A | $321 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $263 | N/A | $263 |
| Office Visit - Established Patient, High Complexity | $263 | N/A | $263 |
| Office Visit - Established Patient, Low Complexity | $158 | N/A | $158 |
| Office Visit - Established Patient, Moderate Complexity | $195 | N/A | $195 |
| Pap Test, automated screening and manual rescreening | $202 | N/A | $202 |
| Pap Test, manual screening | $100 | N/A | $100 |
| Ultrasound - Pelvic (outpatient) | $231 | N/A | $231 |
| Ultrasound - Pregnancy (outpatient) | $273 | N/A | $273 |
| Ultrasound - Pregnancy Follow-Up | $431 | N/A | $431 |
| Ultrasound - Transvaginal (non-maternity) | $236 | N/A | $236 |
| Urine Test - Automated with Microscope Examination | $74 | N/A | $74 |
| Urine Test - Pregnancy | $19 | N/A | $19 |
| Urine Test - Urinalysis, Manual Test | $6 | N/A | $6 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $79 | N/A | $79 |
