| Lab Test - Detection test for Hepatitis B Surface Antigen | $32 | 0% | $32 |
| Office Visit - Basic | $80 | 0% | $80 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $205 | 0% | $205 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $234 | 0% | $234 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $270 | 0% | $270 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $189 | 0% | $189 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $206 | 0% | $206 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $210 | 0% | $210 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $224 | 0% | $224 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $188 | 0% | $188 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $176 | 0% | $176 |
| Office Visit - Established Patient, High Complexity | $261 | 0% | $261 |
| Office Visit - Established Patient, Low Complexity | $131 | 0% | $131 |
| Office Visit - Established Patient, Moderate Complexity | $194 | 0% | $194 |
| Office Visit - New Patient, Low Complexity | $195 | 0% | $195 |
| Office Visit - New Patient, Minor | $128 | 0% | $128 |
| Office Visit - New Patient, Moderate Complexity | $296 | 0% | $296 |
| Psychiatric Diagnostic Evaluation | $238 | 0% | $238 |
| Psychotherapy - 30 Minutes | $116 | 0% | $116 |
| Psychotherapy - 45 Minutes | $154 | 0% | $154 |
| Psychotherapy - Group Session | $58 | 0% | $58 |
| Strep Test (Streptococcus, group A) | $69 | 0% | $69 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $24 | 0% | $24 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $37 | 0% | $37 |
| Urine Test - Chlamydia | $58 | 0% | $58 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $58 | 0% | $58 |
| Urine Test - Urinalysis, Manual Test | $4 | 0% | $4 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $210 | 0% | $210 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $47 | 0% | $47 |
