| Developmental Screening | $37 | N/A | $37 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $43 | N/A | $43 |
| Office Visit - Basic | $139 | N/A | $139 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $341 | N/A | $341 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $267 | N/A | $267 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $291 | N/A | $291 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $305 | N/A | $305 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $329 | N/A | $329 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $266 | N/A | $266 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | N/A | $233 |
| Office Visit - Established Patient, High Complexity | $431 | N/A | $431 |
| Office Visit - Established Patient, Low Complexity | $216 | N/A | $216 |
| Office Visit - Established Patient, Moderate Complexity | $301 | N/A | $301 |
| Office Visit - New Patient, Moderate Complexity | $454 | N/A | $454 |
| Urine Test - Urinalysis, Manual Test | $19 | N/A | $19 |
| Vaccine - Influenza for Injection into Muscle | $35 | N/A | $35 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $74 | N/A | $74 |
