| Lab Test - Detection test for Influenza Virus | $26 | 0% | $26 |
| Office Visit - Basic | $135 | 0% | $135 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $282 | 0% | $282 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $330 | 0% | $330 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $234 | 0% | $234 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $249 | 0% | $249 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $246 | 0% | $246 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $269 | 0% | $269 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $214 | 0% | $214 |
| Office Visit - Established Patient, High Complexity | $311 | 0% | $311 |
| Office Visit - Established Patient, Low Complexity | $169 | 0% | $169 |
| Office Visit - Established Patient, Moderate Complexity | $216 | 0% | $216 |
| Office Visit - New Patient, Low Complexity | $210 | 0% | $210 |
| Office Visit - New Patient, Minor | $166 | 0% | $166 |
| Office Visit - New Patient, Moderate Complexity | $311 | 0% | $311 |
| Strep Test (Streptococcus, group A) | $28 | 0% | $28 |
| Urine Test - Automated without Microscope | $11 | 0% | $11 |
| Urine Test - Pregnancy | $22 | 0% | $22 |
| Urine Test - Urinalysis, Manual Test | $11 | 0% | $11 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $84 | 0% | $84 |
