| Blood Test - Comprehensive Metabolic Panel | $35 | N/A | $35 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $35 | N/A | $35 |
| Lab Test - Detection test for Influenza Virus | $41 | N/A | $41 |
| Office Visit - Basic | $103 | N/A | $103 |
| Office Visit - Established Patient, High Complexity | $343 | N/A | $343 |
| Office Visit - Established Patient, Low Complexity | $235 | N/A | $235 |
| Office Visit - Established Patient, Moderate Complexity | $254 | N/A | $254 |
| Office Visit - New Patient, Low Complexity | $256 | N/A | $256 |
| Office Visit - New Patient, Minor | $176 | N/A | $176 |
| Office Visit - New Patient, Moderate Complexity | $390 | N/A | $390 |
| Urine Test - Automated without Microscope | $14 | N/A | $14 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $90 | N/A | $90 |
| Urine Test - Pregnancy | $21 | N/A | $21 |
| Urine Test - Urinalysis, Manual Test | $57 | N/A | $57 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $97 | N/A | $97 |
| X-Ray - Ankle (outpatient) | $330 | N/A | $330 |
| X-Ray - Chest (outpatient) | $416 | N/A | $416 |
| X-Ray - Foot (outpatient) | $324 | N/A | $324 |
| X-Ray - Hand | $392 | N/A | $392 |
| X-Ray - Knee (outpatient) | $376 | N/A | $376 |
| X-Ray - Shoulder (outpatient) | $334 | N/A | $334 |
| X-Ray - Wrist (outpatient) | $339 | N/A | $339 |
