| Arthrocentesis (outpatient) | $620 | 0% | $620 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $32 | 0% | $32 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $146 | 0% | $146 |
| Office Visit - Basic | $105 | 0% | $105 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $242 | 0% | $242 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $315 | 0% | $315 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $242 | 0% | $242 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $284 | 0% | $284 |
| Office Visit - Established Patient, Low Complexity | $147 | 0% | $147 |
| Office Visit - Established Patient, Moderate Complexity | $200 | 0% | $200 |
| Office Visit - New Patient, Low Complexity | $210 | 0% | $210 |
| Office Visit - New Patient, Moderate Complexity | $294 | 0% | $294 |
| Urine Test - Urinalysis, Manual Test | $32 | 0% | $32 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $105 | 0% | $105 |
