| Office Visit - Basic | $137 | 0% | $137 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $341 | 0% | $341 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $312 | 0% | $312 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $267 | 0% | $267 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $291 | 0% | $291 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $305 | 0% | $305 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $319 | 0% | $319 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $266 | 0% | $266 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $240 | 0% | $240 |
| Office Visit - Established Patient, High Complexity | $431 | 0% | $431 |
| Office Visit - Established Patient, Low Complexity | $210 | 0% | $210 |
| Office Visit - Established Patient, Moderate Complexity | $301 | 0% | $301 |
| Office Visit - New Patient, Moderate Complexity | $454 | 0% | $454 |
| Strep Test (Streptococcus, group A) | $43 | 0% | $43 |
| Urine Test - Urinalysis, Manual Test | $19 | 0% | $19 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $74 | 0% | $74 |
