| Blood Test - Complete Blood Cell Count and Automated WBC | $38 | N/A | $38 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $25 | N/A | $25 |
| Office Visit - Basic | $101 | N/A | $101 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $322 | N/A | $322 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $368 | N/A | $368 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $279 | N/A | $279 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $285 | N/A | $285 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $297 | N/A | $297 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $260 | N/A | $260 |
| Office Visit - Established Patient, High Complexity | $333 | N/A | $333 |
| Office Visit - Established Patient, Low Complexity | $168 | N/A | $168 |
| Office Visit - Established Patient, Moderate Complexity | $246 | N/A | $246 |
| Office Visit - New Patient, Low Complexity | $248 | N/A | $248 |
| Office Visit - New Patient, Minor | $161 | N/A | $161 |
| Office Visit - New Patient, Moderate Complexity | $377 | N/A | $377 |
| Urine Test - Pregnancy | $16 | N/A | $16 |
| Urine Test - Urinalysis, Manual Test | $5 | N/A | $5 |
| Vaccine - Influenza for Injection into Muscle | $36 | N/A | $36 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $75 | N/A | $75 |
