| Developmental Screening | $26 | N/A | $26 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $226 | N/A | $226 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $231 | N/A | $231 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $210 | N/A | $210 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $205 | N/A | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $231 | N/A | $231 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $236 | N/A | $236 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $205 | N/A | $205 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $194 | N/A | $194 |
| Office Visit - Established Patient, High Complexity | $236 | N/A | $236 |
| Office Visit - Established Patient, Low Complexity | $126 | N/A | $126 |
| Office Visit - Established Patient, Moderate Complexity | $179 | N/A | $179 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $58 | N/A | $58 |
