| HC POC URINALYSIS, AUTO W/MICRO | 81001 | $2 |
| Blood Glucose Test | 82947 | $3 |
| PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID | 90460 | $5 |
| HC OCCULT BLOOD SCREEN | 82270 | $6 |
| HC CHOLESTEROL | 82465 | $7 |
| Hemoglobin A1c | 83036 | $8 |
| PR OFFICE/OUTPT VISIT, EST, LEVL I | 99211 | $8 |
| HC HIV 1/2 AB, DONOR EVAL (BLOOD CENTER) | 86703 | $9 |
| Complete Blood Count (CBC) | 85025 | $13 |
| HC PSA, TOTAL-REF LAB ONLY | 84153 | $14 |
| PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID | 90471 | $16 |
| Comprehensive Metabolic Panel | 80053 | $18 |
| PR OFFICE/OUTPT VISIT, EST, LEVL II, 10-19 MIN | 99212 | $18 |
| HC TISSUE, GROSS ONLY, LEVEL I | 88300 | $20 |
| HC SPATH G/M:LVLII | 88302 | $20 |
| Lipid Panel | 80061 | $20 |
| HC SPEC STN GRP I | 88312 | $25 |
| TUBERCULIN PPD 5 TUB. UNIT /0.1 ML IDRM SOLN | 86580 | $25 |
| HC CHLAMYDIA TRACHOMATIS RNA, TMA | 87491 | $27 |
| TSH Thyroid Test | 84443 | $28 |
| HC HPV,HIGH RISK TYPES, POOLED RESULT | 87624 | $29 |
| HC NEISSERIA GONORRHOEAE TMA | 87591 | $29 |
| Therapeutic Injection | 96372 | $31 |
| PR PSYCHOTHERAPY W/PATIENT, 30 MIN | 90832 | $33 |
| Office Visit (Established Patient) | 99213 | $37 |
| Office Visit (Complex) | 99214 | $39 |
| HC OFFICE/OUTPT VISIT, NEW, LEVL II, 15-29 MIN | 99202 | $40 |
| HC OFFICE/OUTPT VISIT, EST, LEVL V, 40-54 MIN | 99215 | $41 |
| Office Visit (New Patient) | 99203 | $42 |
| HC LVL III S/P G/M (NS ONLY) | 88304 | $42 |
| HC OR CONSULT W/FROZ SECT/SMR 1ST | 88331 | $42 |
| HC LVL IV SURG PTH | 88305 | $42 |
| Mammogram (Screening) | 77067 | $44 |
| Office Visit (New, Complex) | 99204 | $44 |
| HC CONSULT OUT. SLIDES W/MATERIAL | 88323 | $44 |
| HC OFFICE/OUTPT VISIT, NEW, LEVL V, 60-74 MIN | 99205 | $46 |
| PR COMPUTERIZED OPHTHALMIC IMAGING RETINA | 92134 | $49 |
| PR PSYCHOTHERAPY W/PATIENT, 45 MIN | 90834 | $49 |
| PR EMERGENCY DEPT VISIT,LEVEL III | 99283 | $55 |
| PR RESUPERF WND BODY <2.5CM | 12001 | $56 |
| HC XRAY, CHEST, 1 VIEW | 71045 | $56 |
| Knee X-Ray | 73560 | $58 |
| HC EMER ROOM LEVEL I | 99281 | $62 |
| HC SHOULDER ROUTINE | 73030 | $63 |
| HC LVL V SURG PTH | 88307 | $63 |
| PR DESTRUCTION(LASER SURGERY,CRYOSURGERY,CHEMOSURGERY),PREMALIGNANT LESIONS,FIRST LESION | 17000 | $69 |
| Chest X-Ray (2 Views) | 71046 | $69 |
| PR SHAV SKIN LES <0.5 CM REMAINDER BODY | 11305 | $73 |
| PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG | 11300 | $73 |
| PR SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG | 11301 | $73 |
| HC DESTRUCT BENIGN LESION 1-14 | 17110 | $73 |
| HC DEXA BONE DENSITY APPEN SKEL | 77081 | $74 |
| PR REMOVAL OF SKIN TAGS, UP TO 15 | 11200 | $74 |
| Psychotherapy (60 min) | 90837 | $74 |
| PR VISUAL FIELD EXAM,EXTENDED | 92083 | $77 |
| PR CORNEAL TOPOGRAPHY | 92025 | $77 |
| PR PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $78 |
| PR PREVENTIVE VISIT,EST,18-39 | 99395 | $79 |
| HC SPATH DIAG COMP | 88309 | $80 |
| PR EYE EXAM, EST PATIENT,INTERMED | 92012 | $83 |
| PR EYE EXAM, EST PATIENT,COMPREHESV | 92014 | $83 |
| PR PREVENTIVE VISIT,EST,40-64 | 99396 | $86 |
| PR PREVENTIVE VISIT,NEW,18-39 | 99385 | $87 |
| HC IV INFUSION - HYDRATION, INITIAL, 31 MIN - 1 HOUR | 96360 | $88 |
| PR PREVENTIVE VISIT,NEW,40-64 | 99386 | $105 |
| HC EMER ROOM LEVEL II | 99282 | $106 |
| PR EYE EXAM, NEW PATIENT,COMPREHESV | 92004 | $111 |
| PR EYE EXAM, NEW PATIENT,INTERMED | 92002 | $111 |
| PR DRAIN/INJECT LARGE JOINT/BURSA | 20610 | $113 |
| PR DRAIN SKIN ABSCESS SIMPLE | 10060 | $116 |
| HC DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEME | 17111 | $120 |
| PR CLOSED RX INTER/SUBTROCH FEMUR FX | 27238 | $121 |
| DEXA Bone Density Scan | 77080 | $121 |
| PR BIOPSY OF PROSTATE,NEEDLE/PUNCH | 55700 | $171 |
| PR INCISION EARDRUM,ASPIR | 69420 | $209 |
| PR EXCIS CHALAZION,SINGLE | 67800 | $261 |
| HC EMER ROOM LEVEL IV | 99284 | $269 |
| Colonoscopy | 45378 | $271 |
| VARICELLA-ZOSTER GE VAC,2 OF 2 50 MCG IM SUSR | 90750 | $278 |
| PR BIOPSY OF BREAST, NEEDLE CORE | 19100 | $297 |
| Colonoscopy with Biopsy | 45380 | $323 |
| Upper Endoscopy with Biopsy | 43239 | $362 |
| PR COLONOSCOPY,REMV LESN,SNARE | 45385 | $384 |
| HC EMER ROOM LEVEL V | 99285 | $397 |
| Epidural Steroid Injection | 64483 | $407 |
| PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG | 11400 | $408 |
| PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG | 11401 | $408 |
| PR EXC SKIN BENIG <0.5 CM FACE,FACIAL | 11440 | $408 |
| Head CT Scan | 70450 | $413 |
| PR TRABECULOPLASTY LASER SURGERY | 65855 | $450 |
| Echocardiogram | 93306 | $469 |
| HC POLYSOMNOGRAPHY, 4 OR MORE | 95810 | $551 |
| PR EXCIS CHALAZION,MULT,BOTH LIDS | 67805 | $652 |
| Lumbar Spine MRI | 72148 | $694 |
| Cervical Spine MRI | 72141 | $694 |
| Knee MRI | 73721 | $719 |
| HC EGD DX (INCL BRUSH/WASH) | 43235 | $794 |
| Brain MRI with Contrast | 70553 | $1,306 |
| Shoulder Arthroscopy | 29827 | $1,318 |
| REMOVE TONSILS AND ADENOIDS | 42820 | $1,383 |
| CREATE EARDRUM OPENING | 69436 | $1,476 |
| REMOVE TONSILS AND ADENOIDS | 42821 | $1,742 |
| PR NASAL/SINUS ENDOSCOPY,BX/RMV POLYP/DEBRID | 31237 | $1,760 |
| REMOVAL OF TONSILS | 42826 | $1,863 |
| EXCISE INFERIOR TURBINATE | 30130 | $2,277 |
| RESECT INFERIOR TURBINATE | 30140 | $2,317 |
| KNEE ARTHROSCOPY/SURGERY | 29881 | $2,570 |
| REPAIR OF NASAL SEPTUM | 30520 | $2,710 |
| VAGINAL HYSTERECTOMY | 58260 | $2,807 |
| Laparoscopic Cholecystectomy | 47562 | $2,952 |
| LAPARO-VAG HYST INCL T/O | 58552 | $3,789 |
| TOTAL HYSTERECTOMY | 58150 | $3,982 |
| PARTICAL MASTECTOMY | 19301 | $4,241 |
| TLH W/T/O 250 G OR LESS | 58571 | $4,827 |
| LAPAROSCOPY APPENDECTOMY | 44970 | $4,878 |
| MAST MOD RAD | 19307 | $4,926 |
| MAST SIMPLE COMPLETE | 19303 | $5,067 |
| KNEE ARTHROSCOPY/SURGERY | 29888 | $6,685 |
| P-MASTECTOMY W/LN REMOVAL | 19302 | $7,001 |