| Office Visit - Basic | $92 | N/A | $92 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $200 | N/A | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $239 | N/A | $239 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $240 | N/A | $240 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $195 | N/A | $195 |
| Office Visit - Established Patient, High Complexity | $307 | N/A | $307 |
| Office Visit - Established Patient, Low Complexity | $154 | N/A | $154 |
| Office Visit - Established Patient, Moderate Complexity | $228 | N/A | $228 |
| Office Visit - New Patient, Low Complexity | $228 | N/A | $228 |
| Office Visit - New Patient, Moderate Complexity | $349 | N/A | $349 |
| Vaccine - Influenza for Injection into Muscle | $39 | N/A | $39 |
