| Lab Test - Detection test for Human Papillomavirus (HPV) | $137 | N/A | $137 |
| Mammogram (outpatient) | $1,198 | N/A | $1,198 |
| Office Visit - Basic | $95 | N/A | $95 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $231 | N/A | $231 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $315 | N/A | $315 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $236 | N/A | $236 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $236 | N/A | $236 |
| Office Visit - Established Patient, High Complexity | $263 | N/A | $263 |
| Office Visit - Established Patient, Low Complexity | $147 | N/A | $147 |
| Office Visit - Established Patient, Moderate Complexity | $236 | N/A | $236 |
| Pap Test, manual screening | $100 | N/A | $100 |
| Ultrasound - Pregnancy (outpatient) | $320 | N/A | $320 |
| Ultrasound - Pregnancy Follow-Up | $263 | N/A | $263 |
| Ultrasound - Transvaginal (non-maternity) | $830 | N/A | $830 |
| Urine Test - Chlamydia | $109 | N/A | $109 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $109 | N/A | $109 |
| Urine Test - Pregnancy | $26 | N/A | $26 |
| Urine Test - Urinalysis, Manual Test | $21 | N/A | $21 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $79 | N/A | $79 |
