| Office Visit - Basic | $87 | N/A | $87 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $184 | N/A | $184 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $200 | N/A | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $204 | N/A | $204 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $217 | N/A | $217 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $182 | N/A | $182 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $171 | N/A | $171 |
| Office Visit - Established Patient, Low Complexity | $135 | N/A | $135 |
| Office Visit - Established Patient, Moderate Complexity | $198 | N/A | $198 |
| Office Visit - New Patient, Low Complexity | $186 | N/A | $186 |
| Office Visit - New Patient, Minor | $129 | N/A | $129 |
| Vaccine - Influenza for Injection into Muscle | $29 | N/A | $29 |
