| Blood Test - Blood Glucose (Sugar) Level | $21 | N/A | $21 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $37 | N/A | $37 |
| Blood Test - Cholesterol Test, Lipid Panel | $63 | N/A | $63 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | N/A | $33 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | N/A | $112 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $378 | N/A | $378 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $176 | N/A | $176 |
| Office Visit - Basic | $79 | N/A | $79 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $236 | N/A | $236 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $210 | N/A | $210 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $205 | N/A | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $221 | N/A | $221 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $226 | N/A | $226 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $184 | N/A | $184 |
| Office Visit - Established Patient, High Complexity | $215 | N/A | $215 |
| Office Visit - Established Patient, Low Complexity | $110 | N/A | $110 |
| Office Visit - Established Patient, Moderate Complexity | $168 | N/A | $168 |
| Office Visit - New Patient, Low Complexity | $163 | N/A | $163 |
| Office Visit - New Patient, Minor | $121 | N/A | $121 |
| Office Visit - New Patient, Moderate Complexity | $263 | N/A | $263 |
| Urine Test - Automated without Microscope | $21 | N/A | $21 |
| Vaccine - Influenza for Injection into Muscle | $37 | N/A | $37 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $68 | N/A | $68 |
