| Office Visit - Basic | $131 | 0% | $131 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $394 | 0% | $394 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $294 | 0% | $294 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $315 | 0% | $315 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $289 | 0% | $289 |
| Office Visit - Established Patient, Low Complexity | $210 | 0% | $210 |
| Office Visit - Established Patient, Moderate Complexity | $315 | 0% | $315 |
| Urine Test - Urinalysis, Manual Test | $8 | 0% | $8 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $63 | 0% | $63 |
