| Office Visit - Basic | $65 | 0% | $65 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $221 | 0% | $221 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $257 | 0% | $257 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $205 | 0% | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $231 | 0% | $231 |
| Office Visit - Established Patient, Low Complexity | $121 | 0% | $121 |
| Office Visit - Established Patient, Moderate Complexity | $163 | 0% | $163 |
| Office Visit - New Patient, Minor | $147 | 0% | $147 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $58 | 0% | $58 |
