| Blood Test - Basic Metabolic Panel | $93 | 0% | $93 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $67 | 0% | $67 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $95 | 0% | $95 |
| Mammogram (outpatient) | $1,198 | 0% | $1,198 |
| Office Visit - Basic | $80 | 0% | $80 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $263 | 0% | $263 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $289 | 0% | $289 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $321 | 0% | $321 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $263 | 0% | $263 |
| Office Visit - Established Patient, High Complexity | $263 | 0% | $263 |
| Office Visit - Established Patient, Low Complexity | $158 | 0% | $158 |
| Office Visit - Established Patient, Moderate Complexity | $195 | 0% | $195 |
| Pap Test | $202 | 0% | $202 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $85 | 0% | $85 |
| Ultrasound - Pelvic (outpatient) | $231 | 0% | $231 |
| Ultrasound - Pregnancy (outpatient) | $273 | 0% | $273 |
| Ultrasound - Pregnancy Follow-Up | $449 | 0% | $449 |
| Ultrasound - Transvaginal (non-maternity) | $236 | 0% | $236 |
| Urine Test - Automated with Microscope Examination | $74 | 0% | $74 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $85 | 0% | $85 |
| Urine Test - Pregnancy | $19 | 0% | $19 |
| Urine Test - Urinalysis, Manual Test | $6 | 0% | $6 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $79 | 0% | $79 |
