| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $41 | 0% | $41 |
| Blood Test - Clotting Time | $27 | 0% | $27 |
| Office Visit - Basic | $89 | 0% | $89 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $289 | 0% | $289 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $359 | 0% | $359 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $263 | 0% | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $328 | 0% | $328 |
| Office Visit - Established Patient, High Complexity | $377 | 0% | $377 |
| Office Visit - Established Patient, Low Complexity | $174 | 0% | $174 |
| Office Visit - Established Patient, Moderate Complexity | $267 | 0% | $267 |
| Office Visit - New Patient, Low Complexity | $269 | 0% | $269 |
| Office Visit - New Patient, Moderate Complexity | $441 | 0% | $441 |
| Urine Test - Automated without Microscope | $11 | 0% | $11 |
| Urine Test - Microalbumin (Protein) Level | $26 | 0% | $26 |
| Urine Test - Urinalysis, Manual Test | $15 | 0% | $15 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $88 | 0% | $88 |
