| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $85 | N/A | $85 |
| Blood Test - Cholesterol Test, Lipid Panel | $111 | N/A | $111 |
| Blood Test - General Health Panel | $316 | N/A | $316 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $141 | N/A | $141 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $100 | N/A | $100 |
| Lab Test - Detection test for Influenza Virus | $32 | N/A | $32 |
| Office Visit - Basic | $104 | N/A | $104 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $348 | N/A | $348 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $348 | N/A | $348 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $413 | N/A | $413 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $328 | N/A | $328 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $254 | N/A | $254 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $323 | N/A | $323 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $328 | N/A | $328 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $389 | N/A | $389 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $229 | N/A | $229 |
| Office Visit - Established Patient, High Complexity | $306 | N/A | $306 |
| Office Visit - Established Patient, Low Complexity | $148 | N/A | $148 |
| Office Visit - Established Patient, Moderate Complexity | $233 | N/A | $233 |
| Office Visit - New Patient, Low Complexity | $268 | N/A | $268 |
| Office Visit - New Patient, Minor | $177 | N/A | $177 |
| Urine Test - Automated without Microscope | $18 | N/A | $18 |
| Vaccine - Influenza for Injection into Muscle | $39 | N/A | $39 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $219 | N/A | $219 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $98 | N/A | $98 |
