| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $22 | 0% | $22 |
| Lab Test - Detection test for Influenza Virus | $32 | 0% | $32 |
| Office Visit - Basic | $68 | 0% | $68 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $233 | 0% | $233 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $227 | 0% | $227 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $307 | 0% | $307 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $206 | 0% | $206 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $189 | 0% | $189 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $197 | 0% | $197 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $223 | 0% | $223 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $231 | 0% | $231 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $250 | 0% | $250 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $197 | 0% | $197 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $181 | 0% | $181 |
| Office Visit - Established Patient, High Complexity | $277 | 0% | $277 |
| Office Visit - Established Patient, Low Complexity | $128 | 0% | $128 |
| Office Visit - Established Patient, Moderate Complexity | $197 | 0% | $197 |
| Office Visit - New Patient, Low Complexity | $187 | 0% | $187 |
| Office Visit - New Patient, Minor | $123 | 0% | $123 |
| Office Visit - New Patient, Moderate Complexity | $319 | 0% | $319 |
| Strep Test (Streptococcus, group A) | $26 | 0% | $26 |
| Urine Test - Pregnancy | $15 | 0% | $15 |
| Urine Test - Urinalysis, Manual Test | $7 | 0% | $7 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $231 | 0% | $231 |
