| Arthrocentesis (outpatient) | $457 | 0% | $457 |
| Destruction of Lesion (outpatient) | $395 | 0% | $395 |
| Office Visit - Basic | $165 | 0% | $165 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $302 | 0% | $302 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $352 | 0% | $352 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $362 | 0% | $362 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $432 | 0% | $432 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $302 | 0% | $302 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $273 | 0% | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $311 | 0% | $311 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $311 | 0% | $311 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $352 | 0% | $352 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $273 | 0% | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | 0% | $233 |
| Office Visit - Established Patient, High Complexity | $456 | 0% | $456 |
| Office Visit - Established Patient, Low Complexity | $225 | 0% | $225 |
| Office Visit - Established Patient, Moderate Complexity | $322 | 0% | $322 |
| Office Visit - New Patient, Low Complexity | $310 | 0% | $310 |
| Strep Test (Streptococcus, group A) | $75 | 0% | $75 |
| Urine Test - Automated without Microscope | $30 | 0% | $30 |
| Urine Test - Pregnancy | $30 | 0% | $30 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $83 | 0% | $83 |
