| Arthrocentesis (outpatient) | $301 | 0% | $301 |
| Biopsy - Tangential Biopsy of Skin | $914 | 0% | $914 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $35 | 0% | $35 |
| Blood Test - Cholesterol Test, Lipid Panel | $141 | 0% | $141 |
| Blood Test - Clotting Time | $15 | 0% | $15 |
| Blood Test - Comprehensive Metabolic Panel | $94 | 0% | $94 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $156 | 0% | $156 |
| Lab Test - Detection test for Influenza Virus | $32 | 0% | $32 |
| Office Visit - Basic | $76 | 0% | $76 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $266 | 0% | $266 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $266 | 0% | $266 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $289 | 0% | $289 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $219 | 0% | $219 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $198 | 0% | $198 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $217 | 0% | $217 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $219 | 0% | $219 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $237 | 0% | $237 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $198 | 0% | $198 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $191 | 0% | $191 |
| Office Visit - Established Patient, High Complexity | $260 | 0% | $260 |
| Office Visit - Established Patient, Low Complexity | $122 | 0% | $122 |
| Office Visit - Established Patient, Moderate Complexity | $185 | 0% | $185 |
| Office Visit - New Patient, Low Complexity | $188 | 0% | $188 |
| Office Visit - New Patient, Minor | $133 | 0% | $133 |
| Office Visit - New Patient, Moderate Complexity | $277 | 0% | $277 |
| Psychiatric Diagnostic Evaluation | $196 | 0% | $196 |
| Psychotherapy - 30 Minutes | $81 | 0% | $81 |
| Psychotherapy - 45 Minutes | $104 | 0% | $104 |
| Psychotherapy - 60 Minutes | $152 | 0% | $152 |
| Psychotherapy - Family Session | $158 | 0% | $158 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Urine Test - Pregnancy | $25 | 0% | $25 |
| Urine Test - Urinalysis, Manual Test | $11 | 0% | $11 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $228 | 0% | $228 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $69 | 0% | $69 |
