| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $315 | 0% | $315 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $368 | 0% | $368 |
| 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 | $289 | 0% | $289 |
| Office Visit - Established Patient, High Complexity | $368 | 0% | $368 |
| Office Visit - Established Patient, Low Complexity | $194 | 0% | $194 |
| Office Visit - Established Patient, Moderate Complexity | $284 | 0% | $284 |
| Office Visit - New Patient, Minor | $184 | 0% | $184 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $368 | 0% | $368 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $105 | 0% | $105 |
