| Office Visit - Basic | $100 | 0% | $100 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $209 | 0% | $209 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $229 | 0% | $229 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $249 | 0% | $249 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $208 | 0% | $208 |
| Office Visit - Established Patient, Low Complexity | $163 | 0% | $163 |
| Office Visit - Established Patient, Moderate Complexity | $242 | 0% | $242 |
| Physical Therapy - High Complexity Evaluation | $116 | 0% | $116 |
| Physical Therapy - Manual Therapy | $47 | 0% | $47 |
| Physical Therapy - Moderate Complexity Evaluation | $116 | 0% | $116 |
| Physical Therapy - Neuromuscular Reeducation | $37 | 0% | $37 |
| Physical Therapy - Re-Evaluation | $79 | 0% | $79 |
| Physical Therapy - Therapeutic Activities | $47 | 0% | $47 |
| Physical Therapy - Therapeutic Exercises | $58 | 0% | $58 |
| Strep Test (Streptococcus, group A) | $34 | 0% | $34 |
