| PSA (Prostate Screening) | 84153 | $13 |
| Urinalysis | 81001 | $14 |
| Blood Glucose Test | 82947 | $17 |
| Gonorrhea Test | 87591 | $18 |
| Chlamydia/Gonorrhea Test | 87491 | $18 |
| Flu Vaccine (quadrivalent) | 90686 | $19 |
| Cholesterol Test | 82465 | $19 |
| Fecal Occult Blood Test | 82270 | $19 |
| Vaccine Administration | 90471 | $20 |
| Cholesterol Panel (Lipids) | 80061 | $21 |
| OCT Eye Scan | 92134 | $32 |
| Complete Blood Count (CBC) | 85025 | $35 |
| Hemoglobin A1c | 83036 | $43 |
| HIV Test | 86703 | $46 |
| Comprehensive Metabolic Panel | 80053 | $47 |
| Established Patient Visit (Level 1) | 99211 | $50 |
| HPV Test | 87624 | $53 |
| Thyroid Stimulating Hormone (TSH) | 84443 | $75 |
| Surgical Pathology (level 1) | 88300 | $109 |
| TB Skin Test (PPD) | 86580 | $109 |
| Immunization Administration (1st vaccine) | 90460 | $110 |
| Eye Exam New Patient (comprehensive) | 92004 | $121 |
| Surgical Pathology (level 2) | 88302 | $175 |
| Surgical Pathology (level 4) | 88305 | $237 |
| Special Stain | 88312 | $237 |
| Surgical Pathology (level 3) | 88304 | $237 |
| Pathology Consultation | 88323 | $237 |
| PT Evaluation – Low Complexity | 97161 | $246 |
| PT Evaluation – Moderate Complexity | 97162 | $246 |
| PT Evaluation – High Complexity | 97163 | $246 |
| Therapeutic Injection | 96372 | $249 |
| Established Patient Visit (Level 2) | 99212 | $290 |
| Established Patient Visit (Level 3) | 99213 | $322 |
| Shingles Vaccine | 90750 | $323 |
| Screening Mammogram | 77067 | $337 |
| Established Patient Visit (Level 4) | 99214 | $354 |
| X-Ray Knee (2 views) | 73560 | $365 |
| X-Ray Shoulder | 73030 | $365 |
| Chest X-Ray (2 views) | 71046 | $365 |
| Chest X-Ray (1 view) | 71045 | $365 |
| Bone Density Scan – Appendicular | 77081 | $365 |
| Established Patient Visit (Level 5) | 99215 | $386 |
| Annual Preventive Visit (18-39) | 99385 | $428 |
| Bone Density Scan (DEXA) | 77080 | $441 |
| Psychotherapy (30 min) | 90832 | $466 |
| Psychotherapy (45 min) | 90834 | $466 |
| Psychotherapy (60 min) | 90837 | $466 |
| Psychiatric Evaluation | 90791 | $466 |
| Skin Tag Removal | 11200 | $556 |
| Abscess Incision & Drainage | 10060 | $556 |
| Shave Removal (0.6-1.0cm) | 11301 | $556 |
| Simple Laceration Repair | 12001 | $556 |
| Destroy Premalignant Lesion (1st) | 17000 | $556 |
| Destroy Wart/Lesion (up to 14) | 17110 | $556 |
| Destroy Wart/Lesion (15 or more) | 17111 | $556 |
| Shave Removal (1.1-2.0cm) | 11305 | $556 |
| Visual Field Test | 92083 | $611 |
| Eye Exam New Patient | 92002 | $612 |
| Eye Exam Established Patient | 92012 | $612 |
| Eye Exam Established (comprehensive) | 92014 | $612 |
| Myringotomy | 69420 | $649 |
| Joint Injection (large) | 20610 | $672 – $897 |
| IV Infusion (first hour) | 96360 | $734 |
| Frozen Section | 88331 | $760 |
| CT Head/Brain | 70450 | $819 |
| Eyelid Cyst Removal | 67800 | $828 |
| Multiple Eyelid Cysts | 67805 | $828 |
| Shave Removal (0.5cm or less) | 11300 | $1,117 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $1,117 |
| Glaucoma Laser Treatment | 65855 | $1,535 |
| Surgical Pathology (level 5) | 88307 | $1,587 |
| Excision Benign Lesion (0.5cm or less) | 11400 | $1,783 |
| Excision Benign Face Lesion (0.5cm) | 11440 | $1,783 |
| Cervical Spine MRI | 72141 | $1,857 |
| MRI Knee | 73721 | $1,857 |
| Lumbar Spine MRI | 72148 | $1,857 |
| Brain MRI with/without contrast | 70553 | $2,263 |
| Epidural Steroid Injection | 64483 | $2,430 |
| Colonoscopy (screening) | 45378 | $2,509 |
| Endoscopy with Biopsy | 43239 | $2,526 |
| Upper GI Endoscopy | 43235 | $2,526 |
| Echocardiogram | 93306 | $2,729 |
| Colonoscopy with Polyp Removal | 45385 | $3,234 |
| Colonoscopy with Biopsy | 45380 | $3,234 |
| Ear Tubes (Tympanostomy) | 69436 | $3,330 – $4,621 |
| Surgical Pathology (level 6) | 88309 | $3,559 |
| Turbinate Ablation | 30801 | $4,054 |
| Breast Biopsy | 19100 | $4,347 |
| Sinus Surgery (FESS) | 31237 | $4,755 |
| Sleep Study (Polysomnography) | 95810 | $4,833 |
| Vasectomy | 55250 | $5,304 |
| Knee Arthroscopy (meniscus) | 29881 | $6,877 – $9,807 |
| Tonsillectomy (Adult) | 42826 | $7,224 – $9,755 |
| Submucous Turbinate Resection | 30140 | $7,224 – $9,755 |
| Tonsillectomy & Adenoidectomy (Adult) | 42821 | $7,224 – $9,755 |
| Turbinate Reduction | 30130 | $7,224 – $9,755 |
| Septoplasty (Deviated Septum Repair) | 30520 | $7,224 – $9,755 |
| ACL Reconstruction | 29888 | $12,106 – $21,676 |
| Shoulder Arthroscopy | 29827 | $12,106 – $21,676 |
| Tonsillectomy & Adenoidectomy (Child) | 42820 | $12,747 – $17,743 |
| Tonsillectomy (Child) | 42825 | $12,747 – $17,743 |
| Appendectomy | 44950 | $14,664 |
| Laparoscopic Appendectomy | 44970 | $15,131 |
| Laparoscopic Cholecystectomy | 47562 | $15,131 |
| Laparoscopic Hernia Repair | 49650 | $15,131 |
| Total Knee Replacement | 27447 | $15,889 |
| Total Hip Replacement | 27130 | $15,889 |