| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $35 | 0% | $35 |
| Blood Test - Clotting Time | $39 | 0% | $39 |
| Office Visit - Basic | $165 | 0% | $165 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | 0% | $281 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $311 | 0% | $311 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $352 | 0% | $352 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $273 | 0% | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | 0% | $233 |
| Office Visit - Established Patient, High Complexity | $456 | 0% | $456 |
| Office Visit - Established Patient, Low Complexity | $225 | 0% | $225 |
| Office Visit - Established Patient, Moderate Complexity | $322 | 0% | $322 |
| Office Visit - New Patient, Low Complexity | $310 | 0% | $310 |
| Office Visit - New Patient, Minor | $263 | 0% | $263 |
| Urine Test - Automated without Microscope | $30 | 0% | $30 |
