| Arthrocentesis (outpatient) | $179 | N/A | $179 |
| Blood Test - Clotting Time | $21 | N/A | $21 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $308 | N/A | $308 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $32 | N/A | $32 |
| Office Visit - Basic | $74 | N/A | $74 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $347 | N/A | $347 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $200 | N/A | $200 |
| 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 | $236 | N/A | $236 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $242 | N/A | $242 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $200 | N/A | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | N/A | $233 |
| Office Visit - Established Patient, High Complexity | $231 | N/A | $231 |
| Office Visit - Established Patient, Low Complexity | $116 | N/A | $116 |
| Office Visit - Established Patient, Moderate Complexity | $168 | N/A | $168 |
| Office Visit - New Patient, Low Complexity | $168 | N/A | $168 |
| Office Visit - New Patient, Minor | $126 | N/A | $126 |
| Office Visit - New Patient, Moderate Complexity | $247 | N/A | $247 |
| Urine Test - Pregnancy | $30 | N/A | $30 |
| Urine Test - Urinalysis, Manual Test | $16 | N/A | $16 |
| Vaccine - Influenza for Injection into Muscle | $32 | N/A | $32 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $50 | N/A | $50 |
