| Office Visit - Basic | $101 | 0% | $101 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $318 | 0% | $318 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $354 | 0% | $354 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $318 | 0% | $318 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $357 | 0% | $357 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $318 | 0% | $318 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $292 | 0% | $292 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $255 | 0% | $255 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $279 | 0% | $279 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $285 | 0% | $285 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $297 | 0% | $297 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $260 | 0% | $260 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $239 | 0% | $239 |
| Office Visit - Established Patient, High Complexity | $333 | 0% | $333 |
| Office Visit - Established Patient, Low Complexity | $168 | 0% | $168 |
| Office Visit - Established Patient, Moderate Complexity | $246 | 0% | $246 |
| Office Visit - New Patient, Low Complexity | $248 | 0% | $248 |
| Office Visit - New Patient, Minor | $161 | 0% | $161 |
| Office Visit - New Patient, Moderate Complexity | $365 | 0% | $365 |
| Strep Test (Streptococcus, group A) | $25 | 0% | $25 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $73 | 0% | $73 |
