| Bacterial Culture - Swab | $32 | 0% | $32 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $17 | 0% | $17 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $23 | 0% | $23 |
| Blood Test - Ferritin (Blood Protein) Level | $59 | 0% | $59 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $60 | 0% | $60 |
| Detection test for Human Papillomavirus (HPV) | $76 | 0% | $76 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $32 | 0% | $32 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $25 | 0% | $25 |
| Lab Test - Smear for Microorganism | $8 | 0% | $8 |
| Mammogram (outpatient) | $916 | 0% | $916 |
| Office Visit - Basic | $71 | 0% | $71 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $252 | 0% | $252 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $284 | 0% | $284 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $226 | 0% | $226 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $242 | 0% | $242 |
| Office Visit - Established Patient, High Complexity | $237 | 0% | $237 |
| Office Visit - Established Patient, Low Complexity | $117 | 0% | $117 |
| Office Visit - Established Patient, Moderate Complexity | $205 | 0% | $205 |
| Office Visit - New Patient, Low Complexity | $176 | 0% | $176 |
| Office Visit - New Patient, Minor | $121 | 0% | $121 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $53 | 0% | $53 |
| Ultrasound - Pelvic (outpatient) | $231 | 0% | $231 |
| Ultrasound - Pregnancy (outpatient) | $378 | 0% | $378 |
| Ultrasound - Pregnancy Follow-Up | $190 | 0% | $190 |
| Ultrasound - Transvaginal (non-maternity) | $205 | 0% | $205 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $41 | 0% | $41 |
| Urine Test - Chlamydia | $57 | 0% | $57 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $57 | 0% | $57 |
| Urine Test - Pregnancy | $19 | 0% | $19 |
| Urine Test - Urinalysis, Manual Test | $11 | 0% | $11 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $84 | 0% | $84 |
