| Bacterial Culture - Aerobic Isolates | $64 | N/A | $64 |
| Bacterial Culture - Swab | $32 | N/A | $32 |
| Blood Test - Blood Typing (ABO) | $5 | N/A | $5 |
| Blood Test - Blood Typing (Rh (D)) | $7 | N/A | $7 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $17 | N/A | $17 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $23 | N/A | $23 |
| Blood Test - Hepatitis C Antibody Level | $185 | N/A | $185 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $60 | N/A | $60 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $147 | N/A | $147 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $32 | N/A | $32 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $25 | N/A | $25 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $76 | N/A | $76 |
| Lab Test - Smear for Microorganism | $8 | N/A | $8 |
| Mammogram (outpatient) | $929 | N/A | $929 |
| Office Visit - Basic | $71 | N/A | $71 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $252 | N/A | $252 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $284 | N/A | $284 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $226 | N/A | $226 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $242 | N/A | $242 |
| Office Visit - Established Patient, High Complexity | $237 | N/A | $237 |
| Office Visit - Established Patient, Low Complexity | $117 | N/A | $117 |
| Office Visit - Established Patient, Moderate Complexity | $205 | N/A | $205 |
| Office Visit - New Patient, Low Complexity | $176 | N/A | $176 |
| Office Visit - New Patient, Minor | $121 | N/A | $121 |
| Pap Test, manual screening | $39 | N/A | $39 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $53 | N/A | $53 |
| Ultrasound - Pelvic (outpatient) | $348 | N/A | $348 |
| Ultrasound - Pregnancy (outpatient) | $378 | N/A | $378 |
| Ultrasound - Pregnancy Follow-Up | $190 | N/A | $190 |
| Ultrasound - Transvaginal (non-maternity) | $205 | N/A | $205 |
| Urine Test - Automated without Microscope | $7 | N/A | $7 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $64 | N/A | $64 |
| Urine Test - Chlamydia | $57 | N/A | $57 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $57 | N/A | $57 |
| Urine Test - Pregnancy | $19 | N/A | $19 |
| Urine Test - Urinalysis, Manual Test | $11 | N/A | $11 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $84 | N/A | $84 |
