| Office Visit - Basic | $118 | 0% | $118 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $359 | 0% | $359 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $402 | 0% | $402 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $312 | 0% | $312 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $333 | 0% | $333 |
| Office Visit - Established Patient, High Complexity | $381 | 0% | $381 |
| Office Visit - Established Patient, Low Complexity | $194 | 0% | $194 |
| Office Visit - Established Patient, Moderate Complexity | $286 | 0% | $286 |
| Office Visit - New Patient, Low Complexity | $289 | 0% | $289 |
| Office Visit - New Patient, Minor | $200 | 0% | $200 |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
| Urine Test - Urinalysis, Manual Test | $18 | 0% | $18 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $439 | 0% | $439 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $95 | 0% | $95 |
