| Lab Test - Detection for Strep (Streptococcus, group A) | $76 | N/A | $76 |
| Office Visit - Basic | $165 | N/A | $165 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $302 | N/A | $302 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $362 | N/A | $362 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $432 | N/A | $432 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $302 | N/A | $302 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $273 | N/A | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $320 | N/A | $320 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $311 | N/A | $311 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $352 | N/A | $352 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $273 | N/A | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | N/A | $233 |
| Office Visit - Established Patient, Low Complexity | $225 | N/A | $225 |
| Office Visit - Established Patient, Moderate Complexity | $322 | N/A | $322 |
| Office Visit - New Patient, Moderate Complexity | $410 | N/A | $410 |
| Urine Test - Automated without Microscope | $31 | N/A | $31 |
| Vaccine - Influenza for Injection into Muscle | $67 | N/A | $67 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $83 | N/A | $83 |
