| Bacterial Culture - Aerobic Isolates | $54 | 0% | $54 |
| Bacterial Culture - Swab | $172 | 0% | $172 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $40 | 0% | $40 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $88 | 0% | $88 |
| Blood Test - Hepatitis C Antibody Level | $195 | 0% | $195 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $194 | 0% | $194 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $131 | 0% | $131 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $237 | 0% | $237 |
| Detection test for Human Papillomavirus (HPV) | $240 | 0% | $240 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $55 | 0% | $55 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $117 | 0% | $117 |
| Lab Test - Smear for Microorganism | $32 | 0% | $32 |
| Mammogram (outpatient) | $812 | 0% | $812 |
| Office Visit - Basic | $158 | 0% | $158 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $289 | 0% | $289 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $298 | 0% | $298 |
| 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 | $394 | 0% | $394 |
| Office Visit - Established Patient, High Complexity | $318 | 0% | $318 |
| Office Visit - Established Patient, Low Complexity | $158 | 0% | $158 |
| Office Visit - Established Patient, Moderate Complexity | $237 | 0% | $237 |
| Pap Test | $126 | 0% | $126 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $35 | 0% | $35 |
| Ultrasound - Pelvic (outpatient) | $578 | 0% | $578 |
| Ultrasound - Pregnancy (outpatient) | $311 | 0% | $311 |
| Ultrasound - Pregnancy Follow-Up | $420 | 0% | $420 |
| Ultrasound - Transvaginal (non-maternity) | $677 | 0% | $677 |
| Urine Test - Automated without Microscope | $30 | 0% | $30 |
| Urine Test - Chlamydia | $170 | 0% | $170 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $170 | 0% | $170 |
| Urine Test - Pregnancy | $26 | 0% | $26 |
| Urine Test - Urinalysis, Manual Test | $16 | 0% | $16 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $74 | 0% | $74 |
