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 $3278.00
Botox $1393.00
Colposcopy $208.00
Colposcopy with Biopsy $272.00
Colposcopy with Biopsy & ECC $293.00
Endo Biospy $208.00
Hysteroscopy D&C Endo Bx $2550.00
Essure $3526.00
LEEP $502.00
IUD- Insertion $200.00
IUD- Kyleena & Insertion $1300.00
IUD- Mirena & Insertion $1300.00
IUD- Paragard & Insertion $1300.00
IUD- Removal $200.00
IUD - Skyla & Insertion $1300.00
Nexplanon & Insertion $1366.00
Nexplanon Removal and Reinsertion $1529.00
Nexplanon Removal $302.00
Polypectomy $242.00
Potassium Challenge Test  $198.00
PFMR (Pelvic Floor Muscle Rehab) $898.00
PFMR (Second Visit and After) $304.00
Rescue Solution $198.00
Urodynamics $1203.00

VACCINES/INJECTIONS

 
Depo Lupron $1135.00
Depo Provera for Contraception $135.00
Flu Shot $61.00
HCG/Pregnyl/Novarel 10,000 units $205.00
HPV/Gardasil Vaccine $235.00
Vaccination Fee $35.00
Injection Fee $35.00
Makena  $935.00
Prolia $1295.00
Reclast Infusion (Outside Facility) $3200 - $6000
Rhogam / Rhophalac 15 Units $188.75          

RADIOLOGY

 
Dexa- Axial $150.00
Digital Mammogram $260.00
Follicle Study Ultrasound $160.00
GYN Ultrasound Transvaginal $200.00
GYN Ultrasound Complete $200.00
GYN Ultrasound Limited $160.00
Salpingogram (Doctor's Fee) $285.00
Salpingogram (Imaging Center/Hospital) $500-$1200
Sonohysterogram $610.00

OBSTETRICS

 
Antepartum 4-6 visits $727.00
Antepartum 7 + visits $1304.00
Amniocentesis (Lab billed separately)  $310.00
OB Ultrasound - Abdominal < 14 weeks $210.00
OB Ultrasound - Abdominal > 14 weeks $230.00
OB Ultrasound - Complete Detailed $325.00
OB Ultrasound - Nuchal Measurement $205.00
OB Ultrasound - Limited $100.00
OB Ultrasound - Repeat $180.00
OB Ultrasound - Transvaginal $160.00
OB Ultrasound - Biophysical w/NST $200.00
OB Ultrasound - Biophysical w/o NST $150.00
OB Ultrasound - Umbilical Doppler $90.00
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 Only $200.00

 HOSPITAL SURGERIES

 
Ablation @ Hospital $1200.00
Anterior & Posterior Repair $1601.00
Essure @ Hospital $1200.00
Hysteroscopy D&C w/w-out Endo bx $550.00
Laparoscopic Tubal Ligation $700.00
Laparoscopy w/removal of Adnex.Struc $1350.00
Laparoscopy w/ Excision of Lesions $1450.00
Sling - Urinary Incon/Atlis/TOT $1379.00
Laparoscopic Sling - Urine Incontinence $1631.00
Laparoscopy - Surgical $620.00
Sterilization w/ C-Section $150.00
Sterilization w/ Vaginal Delivery $636.00
Total Abdominal Hysterectomy $1935.00
Vaginal Hysterectomy w/BSO $1762.00
Vaginal Hysterectomy (LAVH) $1685.00
Vaginal Hysteretomy (LAVH) w/BSO $1883.00

IN-HOUSE LAB PRICING

 
Drawing Fee (Venipuncture) $6.00
28 Week Labs $50.00
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
Cologuard Test (Outside Billing) $600-700
Estradiol $60.00
Fecal Occult Blood $35.00
FSH $40.00
GC/Chlamydia Testing $144.00
Glucose $8.00
Glucose 1 hour $15.00
Glucose 2 hour $26.00
Glucose 3 hour $8.00
HCG Quantitative $25.00
Hemoglobin $8.00
Hemoglobin A1C $25.00
Hemogram $13.00
HBsAg $15.00
Hep C Ab, IgG $30.00
Herpes Simplex 1 & 2 $200.00
HIV 1 and 2 $49.00
HPV Testing $68.00
InformaSeq $815.00
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 $247.00
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 $15.00
Urine Culture $17.00
Vaginitis Panel $85.00
Vitamin D $60.00

CASH SERVICES

 
Labial Femilift $599.00
Vaginal Femilift $899.00
Acupuncture Initial Treatment. Dr. Lorenc $125.00
Acupuncture Follow Up Session $75.00
Acupuncture Int.Treatment + 4 sessions $395.00
Acupuncture Follow up -  5 sessions $325.00
FMLA Forms $20.00
Intensity Device $199.00
My Weight Loss Advantage  
MWLA Consult $100.00
MWLA Consult for Restart $25.00
MWLA Starter Pack $85.00
MWLA Food (per box) $21.00