test company
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test fortw, Indiana 46804 usa
E 40° 0" N 30° 0"
Telephone: (260) 432-4400
Fax: 260

OFFICE VISITS

 
New Patients  
Level I $62.00
Level II $107.00
Level III $154.00
Level IV $236.00
Level V $297.00
Preventative 12-17 years $200.00
Preventative 18-39 years $200.00
Preventative 40-64 years $200.00
Preventative 65 & Older $200.00
Pap Smear $55.00
Established Patients  
Level I $28.00
Level II  $62.00
Level III $105.00
Level IV $154.00
Level V $208.00
Preventative 12-17 years $175.00
Preventative 18-39 years $175.00
Preventative 40-64 years $175.00
Preventative 65 & Older $175.00
Pap Smear $55.00
Consultations/Referrals  
Level I  $75.00
Level II $135.00
Level III $190.00
Level IV $260.00
Level V $320.00

OFFICE PROCEDURES 

 
Ablation $2979.00
Colposcopy $208.00
Colposcopy with Biopsy $272.00
Colposcopy with Biopsy & ECC $293.00
Endo Biospy $208.00
Essure $3526.00
LEEP $502.00
IUD- Insertion $200.00
IUD- Mirena $1100.00
IUD- Paragard $1100.00
IUD- Removal $181.00
IUD - Skyla & Insertion $1050.00
Nexplanon & Insertion $1116.00
Nexplanon Removal $302.00
Potassium Challenge Test  $198.00
PFMR (Pelvic Floor Muscle Rehab) $868.00
PFMR (Second Visit and After) $225.00
Rescue Solution $198.00
Urodynamics $1063.00

VACCINES/INJECTIONS

 
Depo Lupron $1135.00
Depo Provera for Contraception $135.00
Flu Shot $61.00
HPV/Gardasil Vaccine $235.00
Injection Fee $35.00
Prolia $1295.00
Reclast Infusion (Outside Facility) $3200 - $6000

RADIOLOGY

 
Dexa- Axial $150.00
Digital Mammogram $225.00
Follicle Study Ultrasound $100.00
GYN Ultrasound Transvaginal $175.00
GYN Ultrasound Complete $160.00
GYN Ultrasound Limited $100.00
Salpingogram (Doctor's Fee) $224.00
Salpingogram (Imaging Center/Hospital) $450-$1000
Sonohysterogram $524.00

OBSTETRICS

 
Amniocentesis (Lab billed separately)  $310.00
OB Ultrasound - Abdominal < 14 weeks $200.00
OB Ultrasound - Abdominal > 14 weeks $205.00
OB Ultrasound - Complete Detailed $265.00
OB Ultrasound - Nuchal Measurement $175.00
OB Ultrasound - Limited $125.00
OB Ultrasound - Transvaginal $140.00
OB Ultrasound - Biophysical w/NST $180.00
OB Ultrasound - Biophysical w/o NST $140.00
Elective Ultrasound Scan & CD $100.00
Fetal Non-Stress Test $90.00
Vaginal Delivery Global Fee $3400.00
C-Section Delivery Global Fee $3750.00
VBAC Global Fee $3555.00
Post-Partum Check  $0.00

SURGERIES

 
Ablation @ Hospital $1200.00
Anterior & Posterior Repair $1601.00
Essure @ Hospital $1200.00
Laparoscopic Tubal Ligation $700.00
Laparoscopy - Surgical $619.00
Sterilization w/ C-Section $150.00
Sterilization w/ Vaginal Delivery $631.00
Total Abdominal Hysterectomy $1935.00
Vaginal Hysterectomy $1762.00

IN-HOUSE LAB PRICING

 
Drawing Fee (Venipuncture) $5.00
28 Week Labs $47.00
ABO $6.00
Antibody Screen $18.00
BRACA Testing $3300.00
CA-125 $43.00
CBC w/ Auto Diff $16.00
CBC w/o Diff $13.00
CMP - Complete Metabolic Panel $21.00
Estradiol $60.00
Fecal Occult Blood $33.00
FSH $40.00
Glucose $8.00
Glucose 1 hour $12.00
Glucose 2 hour $26.00
Glucose 3 hour $8.00
HCG Quantitative $15.00
Hemoglobin A1C $20.00
Hemogram $13.00
HBsAg $15.00
HIV 1 and 2 $49.00
HPV Testing $72.00
Lipid Panel $28.00
Obstetric Panel $419.00
Pregnancy - Serum Test $15.00
Progesterone $45.00
Prolactin $40.00
Quad Screening $150.00
RH $6.00
Rubella. IGG $32.00
STD Testing $400.00
Syphilis Test (RPR) $27.00
T4 Total and Free $20.00
Triple Screening $110.00
TSH $35.00
Urinalysis, Automated w/Micro $8.00
Urinalysis, Non Automated $5.00
Urinalysis, Dipstick $7.00
Urine Pregnancy Test $13.00
Vaginitis Panel $123.00
Vitamin D $60.00