| Blood Test - Blood Glucose (Sugar) Level | $9 | N/A | $9 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $22 | N/A | $22 |
| Blood Test - Clotting Time | $9 | N/A | $9 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $342 | N/A | $342 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $26 | N/A | $26 |
| Lab Test - Detection test for Influenza Virus | $32 | N/A | $32 |
| Office Visit - Basic | $68 | N/A | $68 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $233 | N/A | $233 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $253 | N/A | $253 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $307 | N/A | $307 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $206 | N/A | $206 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $197 | N/A | $197 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $223 | N/A | $223 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $231 | N/A | $231 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $250 | N/A | $250 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $197 | N/A | $197 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $181 | N/A | $181 |
| Office Visit - Established Patient, High Complexity | $277 | N/A | $277 |
| Office Visit - Established Patient, Low Complexity | $128 | N/A | $128 |
| Office Visit - Established Patient, Moderate Complexity | $197 | N/A | $197 |
| Office Visit - New Patient, Low Complexity | $187 | N/A | $187 |
| Office Visit - New Patient, Minor | $123 | N/A | $123 |
| Office Visit - New Patient, Moderate Complexity | $319 | N/A | $319 |
| Urine Test - Pregnancy | $15 | N/A | $15 |
| Urine Test - Urinalysis, Manual Test | $7 | N/A | $7 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $231 | N/A | $231 |
