| Blood Glucose Test | 82947 | $13 |
| DETERMINE REFRACTIVE STATE | 92015 | $17 |
| BLD OCCLT QL STOOL SINGLE | 82270 | $23 |
| SURG PATHLEVEL I | 88300 | $26 |
| SURG PATHLEVEL II | 88302 | $31 |
| CHOLESTEROL | 82465 | $33 |
| SPECIAL STAINS GROUP I | 88312 | $42 |
| URINE DIP TABLET AUTO MICRO | 81001 | $49 |
| Complete Blood Count (CBC) | 85025 | $50 |
| TB INTRADERMAL TEST | 86580 | $51 |
| SURG PATHLEVEL IV | 88305 | $57 |
| Lipid Panel | 80061 | $57 |
| SURG PATHLEVEL III | 88304 | $58 |
| PAP SCREENING ESTABLISHED PT | 99211 | $59 |
| Hemoglobin A1c | 83036 | $62 |
| BC INFLUENZA ADMIN | 90471 | $63 |
| CONTACT LENS FIT NO SUPPLY | 92310 | $66 |
| HIV1 AND HIV2 SINGLE RESULT | 86703 | $69 |
| Comprehensive Metabolic Panel | 80053 | $80 |
| COMP CORNEAL TOPOGRAPHY UNI BI | 92025 | $93 |
| OPTH IM PT SEG UNI BILAT RET | 92134 | $93 |
| EST PT VISIT LEVEL 2 | 99212 | $95 |
| CLINIC NEW LVL 2 | 99202 | $95 |
| TSH Thyroid Test | 84443 | $97 |
| Office Visit (Established Patient) | 99213 | $98 |
| FROZEN SECTIONS SING SPECIMEN | 88331 | $119 |
| Office Visit (Complex) | 99214 | $127 |
| CHEST SINGLE VIEW | 71045 | $128 |
| Office Visit (New Patient) | 99203 | $131 |
| NEISSERIA GONORRHOEAE AMP PR | 87591 | $134 |
| INFEC AGNT BY NUC ACID CHLAM | 87491 | $134 |
| PROSTATE CANCER SCREENING | 84153 | $143 |
| WOUND CAUTERY 1ST LESION | 17000 | $144 |
| Therapeutic Injection | 96372 | $147 |
| Knee X-Ray | 73560 | $168 |
| HPV HIGH RISK TYPES | 87624 | $171 |
| DESTRUCT LESION 1 14 | 17110 | $172 |
| Office Visit (New, Complex) | 99204 | $172 |
| Mammogram (Screening) | 77067 | $173 |
| SMP REP LESS THANEQUALS 2.5CM S N A G T E | 12001 | $177 |
| REMOVAL SKIN TAGS LESS THAN EQUALS 15 | 11200 | $177 |
| SHAVE LES N HF GENIT 0.5 CM LESS THAN | 11305 | $177 |
| VISUAL FIELD EXAM EXT | 92083 | $181 |
| EST PT VISIT LEVEL 5 | 99215 | $187 |
| DERMPATH CONSULT W SLD PREP | 88323 | $191 |
| EYE EXAM INTERMEDIATEEST PT. | 92012 | $191 |
| EYE EXAMCOMPREHENSIVEEST PT. | 92014 | $191 |
| EYE MED EXAM INTERMED NEW | 92002 | $191 |
| AWV EST AGE 40 64 | 99396 | $195 |
| AWV NEW AGE 40 64 | 99386 | $195 |
| AWV EST AGE 18 39 | 99395 | $195 |
| AWV NEW AGE 18 39 | 99385 | $195 |
| Chest X-Ray (2 Views) | 71046 | $211 |
| SHOULDER COMPLETE | 73030 | $211 |
| DRAIN INJ JNT BURSA MAJ WO ULT | 20610 | $211 |
| ABCESS DRAINAGE SUBQ | 10060 | $262 |
| SHAVE SKIN LESION .6 TO 1.0 CM | 11301 | $262 |
| DESTRUCT LESION 15 OR MORE | 17111 | $262 |
| IV HYDRATE INFUSION IST HR GREATER THAN 30M | 96360 | $271 |
| CLINIC NEW LVL 5 | 99205 | $291 |
| EM SCREENING LVL 1 | 99281 | $306 |
| DEXA RAD WRST HEEL | 77081 | $310 |
| EYE EXAMCOMPREHENSIVENEW PT | 92004 | $320 |
| IND PSYCH TX 16 37M | 90832 | $345 |
| VARICEL ZOS50MCG 0.5MLSHINGRIX | 90750 | $369 |
| SURG PATHLEVEL V | 88307 | $376 |
| IND PSYCH TX 38 52M | 90834 | $376 |
| Psychotherapy (60 min) | 90837 | $410 |
| Head CT Scan | 70450 | $418 |
| DEXA Bone Density Scan | 77080 | $418 |
| PSYCH DIAGNOSTIC EVALUATION | 90791 | $501 |
| SHAVE SKIN LES T EXT 0.5 CM LESS THAN | 11300 | $535 |
| CHALAZION EXC SNG | 67800 | $535 |
| CHALAZION EXC GREATER THAN1 LID MULTIPLE | 67805 | $535 |
| MINOR EM VISIT LVL 2 | 99282 | $584 |
| EXC FACE MM B9 AND MARG 0.5 LESS THAN CM | 11440 | $679 |
| EXC TR EXT B9 AND MARG 0.5 LESS THAN CM | 11400 | $679 |
| EXC TR EXT B9 AND MARG 0.6 1 CM | 11401 | $679 |
| MYRINGOTOMY | 69420 | $680 |
| UPPR GI DIAGNOSTIC BRUSH WASH | 43235 | $749 |
| SURG PATHLEVEL VI | 88309 | $791 |
| TRABECULOPLASTY BY LASER SURGY | 65855 | $796 |
| Epidural Steroid Injection | 64483 | $862 |
| Knee MRI | 73721 | $883 |
| Cervical Spine MRI | 72141 | $883 |
| Lumbar Spine MRI | 72148 | $883 |
| MINOR EM VISIT LVL 3 | 99283 | $1,011 |
| BX BREST PERCU NEEDL W O IMAGE | 19100 | $1,105 |
| Echocardiogram | 93306 | $1,163 |
| COMP POLYSOMNOGRAM AGE 6 AND | 95810 | $1,212 |
| Upper Endoscopy with Biopsy | 43239 | $1,214 |
| Brain MRI with Contrast | 70553 | $1,413 |
| REG EM VISIT LVL 4 | 99284 | $1,593 |
| ABLATE INF TURBINATE SUPERF | 30801 | $1,964 |
| EXT EM VISIT LVL 5 | 99285 | $1,992 |
| NASAL ENDOSCPY BIO AND DEBRIDEMT | 31237 | $3,347 |