| Influenza vaccine, quadrivalent, preservative free, 0.5 mL dosage | 90686 | $3 |
| TSH Thyroid Test | 84443 | $3 |
| Blood Glucose Test | 82947 | $5 |
| Complete Blood Count (CBC) | 85025 | $5 |
| Lipid Panel | 80061 | $5 |
| Cholesterol level | 82465 | $5 |
| Comprehensive Metabolic Panel | 80053 | $5 |
| Manual urinalysis test with examination using microscope, automated | 81001 | $5 |
| Hemoglobin A1c | 83036 | $6 |
| Stool analysis for blood to screen for colon tumors | 82270 | $7 |
| Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique | 87591 | $7 |
| Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique | 87491 | $7 |
| PSA (prostate specific antigen) measurement, total | 84153 | $10 |
| Analysis for antibody to HIV-1 and HIV-2 virus | 86703 | $11 |
| Skin test for tuberculosis | 86580 | $13 |
| Contact lens services both eyes | 92310 | $17 |
| Pathology examination of tissue using a microscope, limited examination | 88300 | $17 |
| Test to determine if prescription eye wear is needed | 92015 | $27 |
| Administration of first vaccine or toxoid component with counseling (18 years or younger) | 90460 | $33 |
| Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | 99211 | $33 |
| Therapeutic Injection | 96372 | $39 |
| EKG (Electrocardiogram) | 93000 | $39 |
| Special stained specimen slides to identify organisms including interpretation and report | 88312 | $39 |
| X-ray of chest, 1 view | 71045 | $46 |
| Emergency department visit for problem that may not require health care professional | 99281 | $46 |
| Chest X-Ray (2 Views) | 71046 | $50 |
| Pathology examination of tissue using a microscope, intermediate complexity | 88305 | $50 |
| Administration of vaccine | 90471 | $52 |
| Pathology examination of tissue using a microscope | 88302 | $54 |
| DXA bone density measurement of forearm, finger, hand, or foot | 77081 | $56 |
| Pathology examination of tissue using a microscope, moderately low complexity | 88304 | $63 |
| CT scan of cornea | 92025 | $64 |
| New patient problem focused exam of visual system | 92002 | $65 |
| New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more | 99202 | $65 |
| Established patient problem focused exam of visual system | 92012 | $65 |
| Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | 99212 | $65 |
| Destruction of precancer skin growth, 1 growth | 17000 | $70 |
| Destruction of skin growth, 1-14 growths | 17110 | $70 |
| Removal of skin tag, 1-15 skin tags | 11200 | $70 |
| BIOPSY SKIN LESION | 11100 | $70 |
| Initial new patient preventive medicine evaluation (18-39 years) | 99385 | $72 |
| Initial new patient preventive medicine evaluation (40-64 years) | 99386 | $72 |
| Established patient periodic preventive medicine examination (40-64 years) | 99396 | $72 |
| Established patient periodic preventive medicine examination (18-39 years) | 99395 | $72 |
| Imaging of retina | 92134 | $72 |
| Simple or single drainage of skin abscess | 10060 | $78 |
| Knee X-Ray | 73560 | $78 |
| Office Visit (Established Patient) | 99213 | $78 |
| Emergency department visit with straightforward medical decision making | 99282 | $78 |
| New patient complete exam of visual system | 92004 | $78 |
| Established patient complete exam of visual system | 92014 | $78 |
| Office Visit (Complex) | 99214 | $85 |
| Office Visit (New Patient) | 99203 | $85 |
| Detection test by nucleic acid for Human Papillomavirus (HPV), high-risk types | 87624 | $91 |
| X-ray of shoulder, minimum of 2 views | 73030 | $91 |
| Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 99215 | $98 |
| Office Visit (New, Complex) | 99204 | $98 |
| Aspiration and/or injection of fluid from large joint | 20610 | $98 |
| Pathology examination of specimen during surgery, first tissue block | 88331 | $101 |
| Infusion into a vein for hydration, 31-60 minutes | 96360 | $104 |
| Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm | 11301 | $106 |
| Shaving of skin growth of body, arms, or legs, 0.5 cm or less | 11300 | $106 |
| Destruction of skin growth, 15 or more growths | 17111 | $106 |
| Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less | 11305 | $106 |
| New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | 99205 | $111 |
| Emergency department visit with low level of medical decision making | 99283 | $117 |
| Exam of visual field with extended testing | 92083 | $135 |
| DEXA Bone Density Scan | 77080 | $136 |
| Surgical pathology consultation and report on referred material requiring preparation of slides | 88323 | $145 |
| Psychotherapy, 30 minutes | 90832 | $146 |
| Psychotherapy, 45 minutes | 90834 | $157 |
| Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less | 12001 | $163 |
| Mammogram (Screening) | 77067 | $166 |
| Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less | 11440 | $169 |
| Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm | 11401 | $171 |
| Removal of multiple chronic growths of different eyelids | 67805 | $181 |
| Incision, aspiration, and/or inflation of eardrum | 69420 | $182 |
| Pathology examination of tissue using a microscope, moderately high complexity | 88307 | $183 |
| Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less | 11400 | $189 |
| Psychotherapy (60 min) | 90837 | $203 |
| Psychiatric diagnostic evaluation | 90791 | $209 |
| Emergency department visit with moderate level of medical decision making | 99284 | $211 |
| Shingles vaccine for injection into muscle | 90750 | $215 |
| Pathology examination of tissue using a microscope, high complexity | 88309 | $239 |
| Needle biopsy of breast | 19100 | $240 |
| Removal of chronic growth of eyelid | 67800 | $244 |
| Emergency department visit with high level of medical decision making | 99285 | $325 |
| Destruction of soft tissue of nasal passages | 30801 | $373 |
| Head CT Scan | 70450 | $398 |
| Biopsy of prostate gland | 55700 | $444 |
| Laser repair to improve eye fluid flow | 65855 | $468 |
| Echocardiogram | 93306 | $478 |
| Biopsy or removal of nasal polyp or tissue using an endoscope | 31237 | $493 |
| Removal of tonsils (younger than 12 years) | 42825 | $513 |
| Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope | 43235 | $514 |
| Removal of tonsils and adenoid glands (younger than 12 years) | 42820 | $560 |
| Incision of eardrum with placement of eardrum tube under general anesthesia | 69436 | $587 |
| Upper Endoscopy with Biopsy | 43239 | $598 |
| Epidural Steroid Injection | 64483 | $612 |
| Removal of tonsils and adenoid glands (12 years or older) | 42821 | $623 |
| Removal of tonsils (12 years or older) | 42826 | $625 |
| Colonoscopy | 45378 | $683 |
| Closed treatment of broken below neck of thigh bone | 27238 | $774 |
| Colonoscopy with Biopsy | 45380 | $819 |
| Removal of polyps or growths of large bowel using an endoscope with mechanical snare | 45385 | $923 |
| Lumbar Spine MRI | 72148 | $936 |
| PR XURETHRAL RESEC PROSTATE,1ST STAGE | 52612 | $952 |
| Cervical Spine MRI | 72141 | $963 |
| Removal of nasal air passage | 30130 | $966 |
| Removal of appendix using an endoscope | 44970 | $1,020 |
| Removal of nasal air passage under lining tissue | 30140 | $1,100 |
| Removal of appendix | 44950 | $1,110 |
| Reshaping of nasal cartilage | 30520 | $1,142 |
| Partial removal of breast | 19301 | $1,168 |
| Sleep study in sleep lab | 95808 | $1,257 |
| Removal of uterus through vagina, 250.0 g or less | 58260 | $1,267 |
| Laparoscopic Cholecystectomy | 47562 | $1,437 |
| Sleep study in sleep lab (6 years or older) | 95810 | $1,439 |
| Removal of ruptured infected appendix | 44960 | $1,499 |
| Brain MRI with Contrast | 70553 | $1,528 |
| Knee MRI | 73721 | $1,550 |
| Removal of prostate gland using an electrocautery knife through urethra with control of bleeding using an endoscope | 52601 | $1,637 |
| Removal of knee cartilage using an endoscope | 29881 | $1,749 |
| Removal of uterus and cervix through abdomen | 58150 | $1,815 |
| Removal of uterus, tubes, and/or ovaries through abdomen using an endoscope, 250.0 g or less | 58571 | $1,856 |
| Simple complete removal of breast | 19303 | $1,950 |
| Removal of uterus, tubes, and/or ovaries through vagina using an endoscope, 250.0 g or less | 58552 | $2,028 |
| Partial removal of breast and underarm lymph nodes | 19302 | $2,276 |
| Shoulder Arthroscopy | 29827 | $2,863 |
| Removal of breast and underarm lymph nodes | 19307 | $2,995 |
| Surgical removal of prostate and surrounding lymph nodes using an endoscope | 55866 | $3,438 |
| Repair of anterior cruciate ligament of knee using an endoscope | 29888 | $3,872 |
| Treatment of upper end of broken thigh bone with placement of stabilizing device or prosthetic replacement | 27236 | $3,980 |
| Total Hip Replacement | 27130 | $4,434 |
| Total Knee Replacement | 27447 | $4,996 |
| Revision of component of total knee joint prosthesis | 27486 | $5,693 |
| Revision of thigh and lower leg bone components of total knee joint prosthesis | 27487 | $7,307 |