OFFICE VISITS |
|
| New Patients | |
| Level I | $75.00 |
| Level II | $125.00 |
| 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 |
| HPV Testing | $68.00 |
| 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 |
| HPV Testing | $68.00 |
| Consultations/Referrals | |
| Level I | $75.00 |
| Level II | $135.00 |
| Level III | $190.00 |
| Level IV | $280.00 |
| Level V | $340.00 |
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 | $2100.00 |
| IUD- Mirena & Insertion | $2100.00 |
| IUD- Paragard & Insertion | $2100.00 |
| IUD- Removal | $300.00 |
| IUD - Skyla & Insertion | $2100.00 |
| Nexplanon & Insertion | $2100.00 |
| Nexplanon Removal and Reinsertion | $2300.00 |
| Nexplanon Removal | $300.00 |
| Polypectomy | $242.00 |
| Potassium Challenge Test | $198.00 |
| PFMR (Pelvic Floor Muscle Rehab) | $965.00 |
| PFMR (Second Visit and After) | $304.00 |
| Rescue Solution | $198.00 |
| Urodynamics | $1203.00 |
VACCINES/INJECTIONS |
|
| Depo Lupron | $1210.00 |
| Depo Provera for Contraception | $135.00 |
| Flu Shot | $61.00 |
| HCG/Pregnyl/Novarel 10,000 units | $205.00 |
| HPV/Gardasil Vaccine | $335.00 |
| Hydroxyprogesterone, 10mg | $910.00 |
| Vaccination Fee | $35.00 |
| Injection Fee | $35.00 |
| Makena | $1035.00 |
| Prolia | $1535.00 |
| 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 | $150.00 |
| OB Ultrasound - Repeat | $180.00 |
| OB Ultrasound - Transvaginal | $200.00 |
| 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 | $1350.00 |
| 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) | $10.00 |
| 28 Week Labs | $50.00 |
| ABO | $8.00 |
| Antibody Screen | $18.00 |
| BRACA Testing | $3300.00 |
| CA-125 | $43.00 |
| CBC w/ Auto Diff | $20.00 |
| CBC w/o Diff | $15.00 |
| 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 | $164.00 |
| Glucose | $10.00 |
| 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 | $45.00 |
| Quad Screening | $150.00 |
| RH | $8.00 |
| Rubella. IGG | $32.00 |
| STD Testing | $250.00 |
| Syphilis Test (RPR) | $27.00 |
| T4 Total and Free | $20.00 |
| Triple Screening | $110.00 |
| TSH | $40.00 |
| 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 | $150.00 |
| Vitamin D | $70.00 |
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 |
test company
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test fortw, Indiana
46804
usa
E 40° 0"
N 30° 0"
Telephone: (260) 432-4400
Fax: 260