| Arthrocentesis (outpatient) | $389 | 0% | $389 |
| Blood Test - Cholesterol Test, Lipid Panel | $156 | 0% | $156 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $137 | 0% | $137 |
| Blood Test - Vitamin D-3 Level | $254 | 0% | $254 |
| Office Visit - Basic | $88 | 0% | $88 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $268 | 0% | $268 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $260 | 0% | $260 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $301 | 0% | $301 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $234 | 0% | $234 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $250 | 0% | $250 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $208 | 0% | $208 |
| Office Visit - Established Patient, Low Complexity | $146 | 0% | $146 |
| Office Visit - Established Patient, Moderate Complexity | $215 | 0% | $215 |
| Office Visit - New Patient, Moderate Complexity | $329 | 0% | $329 |
| Urine Test - Urinalysis, Manual Test | $9 | 0% | $9 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $77 | 0% | $77 |
