| Arthrocentesis (outpatient) | $179 | 0% | $179 |
| Blood Test - Clotting Time | $21 | 0% | $21 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | 0% | $33 |
| Blood Test - Comprehensive Metabolic Panel | $48 | 0% | $48 |
| Office Visit - Basic | $74 | 0% | $74 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $247 | 0% | $247 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $347 | 0% | $347 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $200 | 0% | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $200 | 0% | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $236 | 0% | $236 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $242 | 0% | $242 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $200 | 0% | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $208 | 0% | $208 |
| Office Visit - Established Patient, High Complexity | $231 | 0% | $231 |
| Office Visit - Established Patient, Low Complexity | $116 | 0% | $116 |
| Office Visit - Established Patient, Moderate Complexity | $168 | 0% | $168 |
| Office Visit - New Patient, Low Complexity | $158 | 0% | $158 |
| Office Visit - New Patient, Minor | $126 | 0% | $126 |
| Strep Test (Streptococcus, group A) | $32 | 0% | $32 |
| Urine Test - Pregnancy | $27 | 0% | $27 |
| Urine Test - Urinalysis, Manual Test | $16 | 0% | $16 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $50 | 0% | $50 |
