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 | $104.00 |
| 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 | $3120.00 |
| Colposcopy | $208.00 |
| Colposcopy with Biopsy | $272.00 |
| Colposcopy with Biopsy & ECC | $293.00 |
| Endo Biospy | $208.00 |
| Essure | $3490.00 |
| 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 | $1117.00 |
| Nexplanon Removal | $272.00 |
| Potassium Challenge Test | $198.00 |
| PFMR (Pelvic Floor Muscle Rehab) | $589.00 |
| PFMR (Second Visit and After) | $224.00 |
| Rescue Solution | $272.00 |
| Urodynamics | $1178.00 |
VACCINES/INJECTIONS |
|
| Depo Lupron | $985.00 |
| Depo Provera for Contraception | $155.00 |
| Flu Shot | $60.00 |
| 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 | $130.00 |
| GYN Ultrasound Transvaginal | $196.00 |
| GYN Ultrasound Complete | $180.00 |
| GYN Ultrasound Limited | $130.00 |
| Salpingogram (Doctor's Fee) | $224.00 |
| Salpingogram (Imaging Center/Hospital) | $600-$1200 |
| Sonohysterogram | $414.00 |
OBSTETRICS |
|
| Amniocentesis (Lab billed separately) | $313.00 |
| OB Ultrasound - Abdominal < 14 weeks | $200.00 |
| OB Ultrasound - Abdominal > 14 weeks | $230.00 |
| OB Ultrasound - Complete Detailed | $294.00 |
| OB Ultrasound - Nuchal Measurement | $197.00 |
| OB Ultrasound - Limited | $136.00 |
| OB Ultrasound - Transvaginal | $165.00 |
| OB Ultrasound - Biophysical w/NST | $196.00 |
| OB Ultrasound - Biophysical w/o NST | $143.00 |
| Elective Ultrasound Scan & CD | $100.00 |
| Fetal Non-Stress Test | $90.00 |
| Vaginal Delivery Global Fee | $3400.00 |
| C-Section Delivery Global Fee | $3770.00 |
| VBAC Global Fee | $3555.00 |
| Post-Partum Check | $0.00 |
SURGERIES |
|
| Ablation @ Hospital | $1200.00 |
| Anterior & Posterior Repair | $1601.00 |
| Essure @ Hospital | $1305.00 |
| Laparoscopic Tubal Ligation | $700.00 |
| Laparoscopy - Surgical | $625.00 |
| Sterilization w/ C-Section | $150.00 |
| Sterilization w/ Vaginal Delivery | $631.00 |
| Total Abdominal Hysterectomy | $1944.00 |
| Vaginal Hysterectomy | $1895.00 |
IN-HOUSE LAB PRICING |
|
| Drawing Fee (Venipuncture) | $5.00 |
| 28 Week Labs | $45.00 |
| ABO | $8.00 |
| Antibody Screen | $18.00 |
| BRACA Testing | $3300.00 |
| CA-125 | $50.00 |
| CBC w/ Auto Diff | $20.00 |
| CBC w/o Diff | $15.00 |
| CMP - Complete Metabolic Panel | $25.00 |
| Estradiol | $60.00 |
| Fecal Occult Blood | $33.00 |
| FSH | $40.00 |
| Glucose | $10.00 |
| Glucose 1 hour | $12.00 |
| Glucose 2 hour | $30.00 |
| Glucose 3 hour | $8.00 |
| HCG Quantitative | $15.00 |
| Hemoglobin A1C | $25.00 |
| Hemogram | $15.00 |
| HBsAg | $15.00 |
| HIV 1 and 2 | $30.00 |
| HPV Testing | $72.00 |
| Lipid Panel | $40.00 |
| Obstetric Panel | $350.00 |
| Pregnancy - Serum Test | $15.00 |
| Progesterone | $45.00 |
| Prolactin | $40.00 |
| Quad Screening | $150.00 |
| RH | $8.00 |
| Rubella. IGG | $32.00 |
| STD Testing | $500.00 |
| Syphilis Test (RPR) | $25.00 |
| T4 Total and Free | $34.00 |
| Triple Screening | $100.00 |
| TSH | $35.00 |
| Urinalysis, Automated w/Micro | $8.00 |
| Urinalysis, Non Automated | $5.00 |
| Urinalysis, Dipstick | $7.00 |
| Urine Pregnancy Test | $15.00 |
| Vaginitis Panel | $85.00 |
| Vitamin D | $60.00 |
test company
test tagline
test street
test address
test fortw, Indiana
46804
usa
E 40° 0"
N 30° 0"
Telephone: (260) 432-4400
Fax: 260