| Office Visit - Basic | $108 | 0% | $108 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $364 | 0% | $364 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $334 | 0% | $334 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $395 | 0% | $395 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $313 | 0% | $313 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $364 | 0% | $364 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $285 | 0% | $285 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $291 | 0% | $291 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $313 | 0% | $313 |
| Office Visit - Established Patient, High Complexity | $353 | 0% | $353 |
| Office Visit - Established Patient, Low Complexity | $183 | 0% | $183 |
| Office Visit - Established Patient, Moderate Complexity | $264 | 0% | $264 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $88 | 0% | $88 |
