| Biopsy - Punch Biopsy of Skin | $945 | 0% | $945 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $47 | 0% | $47 |
| Blood Test - Clotting Time | $55 | 0% | $55 |
| Detection test for Human Papillomavirus (HPV) | $355 | 0% | $355 |
| Lab Test - Detection test for Influenza Virus | $42 | 0% | $42 |
| Office Visit - Basic | $92 | 0% | $92 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $268 | 0% | $268 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $294 | 0% | $294 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $210 | 0% | $210 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $202 | 0% | $202 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $221 | 0% | $221 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $242 | 0% | $242 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $252 | 0% | $252 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $205 | 0% | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $184 | 0% | $184 |
| Office Visit - Established Patient, High Complexity | $273 | 0% | $273 |
| Office Visit - Established Patient, Low Complexity | $147 | 0% | $147 |
| Office Visit - Established Patient, Moderate Complexity | $194 | 0% | $194 |
| Office Visit - New Patient, Low Complexity | $205 | 0% | $205 |
| Office Visit - New Patient, Minor | $142 | 0% | $142 |
| Office Visit - New Patient, Moderate Complexity | $289 | 0% | $289 |
| Pap Test | $239 | 0% | $239 |
| Psychiatric Diagnostic Evaluation | $168 | 0% | $168 |
| Psychotherapy - 30 Minutes | $116 | 0% | $116 |
| Psychotherapy - 45 Minutes | $142 | 0% | $142 |
| Psychotherapy - 60 Minutes | $173 | 0% | $173 |
| Psychotherapy - Family Session | $158 | 0% | $158 |
| Psychotherapy - Group Session | $58 | 0% | $58 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $62 | 0% | $62 |
| Urine Test - Automated with Microscope Examination | $47 | 0% | $47 |
| Urine Test - Automated without Microscope | $18 | 0% | $18 |
| Urine Test - Pregnancy | $33 | 0% | $33 |
| Urine Test - Urinalysis, Manual Test | $17 | 0% | $17 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $79 | 0% | $79 |
