| Blood Test - Clotting Time | $50 | 0% | $50 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $373 | 0% | $373 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $373 | 0% | $373 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $294 | 0% | $294 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $320 | 0% | $320 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $320 | 0% | $320 |
| Office Visit - Established Patient, Low Complexity | $221 | 0% | $221 |
| Office Visit - Established Patient, Moderate Complexity | $305 | 0% | $305 |
| Office Visit - New Patient, Low Complexity | $263 | 0% | $263 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $89 | 0% | $89 |
