| Developmental Screening | $48 | N/A | $48 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $278 | N/A | $278 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $302 | N/A | $302 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $303 | N/A | $303 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $332 | N/A | $332 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $277 | N/A | $277 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $251 | N/A | $251 |
| Office Visit - Established Patient, Low Complexity | $147 | N/A | $147 |
| Office Visit - Established Patient, Moderate Complexity | $215 | N/A | $215 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $75 | N/A | $75 |
