| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $36 | N/A | $36 |
| Office Visit - Basic | $165 | N/A | $165 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | N/A | $281 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $320 | N/A | $320 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $352 | N/A | $352 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $273 | N/A | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | N/A | $233 |
| Office Visit - Established Patient, High Complexity | $456 | N/A | $456 |
| Office Visit - Established Patient, Low Complexity | $225 | N/A | $225 |
| Office Visit - Established Patient, Moderate Complexity | $322 | N/A | $322 |
| Office Visit - New Patient, Low Complexity | $310 | N/A | $310 |
| Vaccine - Influenza for Injection into Muscle | $67 | N/A | $67 |
