| Blood Test - Basic Metabolic Panel | $25 | N/A | $25 |
| Blood Test - Lead Level | $25 | N/A | $25 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $28 | N/A | $28 |
| Lab Test - Detection test for Influenza Virus | $35 | N/A | $35 |
| Office Visit - Basic | $141 | N/A | $141 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $294 | N/A | $294 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $282 | N/A | $282 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $343 | N/A | $343 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $234 | N/A | $234 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $254 | N/A | $254 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $255 | N/A | $255 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $279 | N/A | $279 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $235 | N/A | $235 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $214 | N/A | $214 |
| Office Visit - Established Patient, High Complexity | $284 | N/A | $284 |
| Office Visit - Established Patient, Low Complexity | $175 | N/A | $175 |
| Office Visit - Established Patient, Moderate Complexity | $216 | N/A | $216 |
| Office Visit - New Patient, Low Complexity | $210 | N/A | $210 |
| Office Visit - New Patient, Minor | $166 | N/A | $166 |
| Office Visit - New Patient, Moderate Complexity | $311 | N/A | $311 |
| Urine Test - Automated without Microscope | $11 | N/A | $11 |
| Urine Test - Pregnancy | $22 | N/A | $22 |
| Urine Test - Urinalysis, Manual Test | $11 | N/A | $11 |
| Vaccine - Influenza for Injection into Muscle | $32 | N/A | $32 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $84 | N/A | $84 |
