| Mammogram (outpatient) | $1,051 | 0% | $1,051 | 
Medium |
| Office Visit - Basic | $74 | 0% | $74 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $231 | 0% | $231 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $315 | 0% | $315 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $236 | 0% | $236 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $236 | 0% | $236 |
Medium |
| Office Visit - Established Patient, High Complexity | $263 | 0% | $263 |
Medium |
| Office Visit - Established Patient, Low Complexity | $147 | 0% | $147 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $236 | 0% | $236 |
Medium |
| Ultrasound - Pelvic (outpatient) | $740 | 0% | $740 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $320 | 0% | $320 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $929 | 0% | $929 |
Medium |
| Urine Test - Pregnancy | $26 | 0% | $26 |
Medium |
