| Lab Test - Detection test for Influenza Virus | $37 | 0% | $37 |
| Office Visit - Basic | $121 | 0% | $121 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $326 | 0% | $326 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $326 | 0% | $326 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $273 | 0% | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $273 | 0% | $273 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $299 | 0% | $299 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $221 | 0% | $221 |
| Office Visit - Established Patient, High Complexity | $326 | 0% | $326 |
| Office Visit - Established Patient, Low Complexity | $194 | 0% | $194 |
| Office Visit - Established Patient, Moderate Complexity | $257 | 0% | $257 |
| Office Visit - New Patient, Low Complexity | $247 | 0% | $247 |
| Office Visit - New Patient, Minor | $221 | 0% | $221 |
| Office Visit - New Patient, Moderate Complexity | $368 | 0% | $368 |
| Psychiatric Diagnostic Evaluation | $184 | 0% | $184 |
| Psychotherapy - 60 Minutes | $158 | 0% | $158 |
| Psychotherapy - Family Session | $158 | 0% | $158 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Urine Test - Automated without Microscope | $11 | 0% | $11 |
| Urine Test - Pregnancy | $26 | 0% | $26 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $242 | 0% | $242 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $63 | 0% | $63 |
