| Urinalysis | 81001 | $6 – $10 |
| Fecal Occult Blood Test | 82270 | $8 – $13 |
| X-Ray Knee (2 views) | 73560 | $10 – $21 |
| Chest X-Ray (1 view) | 71045 | $11 – $23 |
| X-Ray Shoulder | 73030 | $11 – $24 |
| Bone Density Scan (DEXA) | 77080 | $12 – $25 |
| Chest X-Ray (2 views) | 71046 | $12 – $27 |
| Complete Blood Count (CBC) | 85025 | $13 – $23 |
| Hemoglobin A1c | 83036 | $17 – $29 |
| HIV Test | 86703 | $22 – $40 |
| Cholesterol Panel (Lipids) | 80061 | $27 – $47 |
| Thyroid Stimulating Hormone (TSH) | 84443 | $29 – $48 |
| Cholesterol Test | 82465 | $31 – $52 |
| PSA (Prostate Screening) | 84153 | $31 – $53 |
| Surgical Pathology (level 1) | 88300 | $32 – $50 |
| Screening Mammogram | 77067 | $44 – $94 |
| Therapeutic Injection | 96372 | $47 – $123 |
| CT Head/Brain | 70450 | $49 – $105 |
| Surgical Pathology (level 2) | 88302 | $50 – $80 |
| Joint Injection (large) | 20610 | $53 – $114 |
| Simple Laceration Repair | 12001 | $56 – $112 |
| Gonorrhea Test | 87591 | $59 – $101 |
| Chlamydia/Gonorrhea Test | 87491 | $59 – $101 |
| HPV Test | 87624 | $59 – $101 |
| Vaccine Administration | 90471 | $67 – $100 |
| Special Stain | 88312 | $68 – $108 |
| Pathology Consultation | 88323 | $68 – $108 |
| Surgical Pathology (level 4) | 88305 | $68 – $108 |
| Surgical Pathology (level 3) | 88304 | $68 – $108 |
| Established Patient Visit (Level 1) | 99211 | $71 – $143 |
| Comprehensive Metabolic Panel | 80053 | $77 – $130 |
| MRI Knee | 73721 | $77 – $165 |
| Echocardiogram | 93306 | $83 – $179 |
| Established Patient Visit (Level 2) | 99212 | $85 – $171 |
| Lumbar Spine MRI | 72148 | $85 – $181 |
| Cervical Spine MRI | 72141 | $85 – $181 |
| Skin Tag Removal | 11200 | $89 – $181 |
| New Patient Visit (Level 2) | 99202 | $89 – $181 |
| Excision Benign Lesion (0.5cm or less) | 11400 | $99 – $200 |
| Destroy Wart/Lesion (15 or more) | 17111 | $100 – $201 |
| Established Patient Visit (Level 3) | 99213 | $106 – $213 |
| Abscess Incision & Drainage | 10060 | $122 – $246 |
| Excision Benign Face Lesion (0.5cm) | 11440 | $125 – $253 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $126 – $255 |
| New Patient Visit (Level 3) | 99203 | $130 – $261 |
| Brain MRI with/without contrast | 70553 | $131 – $279 |
| Established Patient Visit (Level 4) | 99214 | $149 – $300 |
| Upper GI Endoscopy | 43235 | $151 – $304 |
| Endoscopy with Biopsy | 43239 | $170 – $342 |
| PT Evaluation – Low Complexity | 97161 | $173 – $283 |
| New Patient Visit (Level 4) | 99204 | $194 – $390 |
| Laparoscopic Cholecystectomy | 47562 | $204 – $411 |
| Established Patient Visit (Level 5) | 99215 | $209 – $422 |
| Frozen Section | 88331 | $217 – $347 |
| Colonoscopy (screening) | 45378 | $227 – $459 |
| PT Evaluation – Moderate Complexity | 97162 | $228 – $373 |
| Colonoscopy with Biopsy | 45380 | $246 – $497 |
| New Patient Visit (Level 5) | 99205 | $255 – $515 |
| IV Infusion (first hour) | 96360 | $277 – $459 |
| Vasectomy | 55250 | $278 – $561 |
| PT Evaluation – High Complexity | 97163 | $282 – $462 |
| Appendectomy | 44950 | $286 – $402 |
| Colonoscopy with Polyp Removal | 45385 | $313 – $631 |
| Surgical Pathology (level 5) | 88307 | $453 – $724 |
| Laparoscopic Hernia Repair | 49650 | $531 – $1,072 |
| Sinus Surgery (FESS) | 31237 | $591 – $1,142 |
| Laparoscopic Appendectomy | 44970 | $744 – $1,500 |
| Surgical Pathology (level 6) | 88309 | $1,019 – $1,626 |
| Sleep Study (Limited) | 95808 | $1,694 – $2,316 |
| Sleep Study (Polysomnography) | 95810 | $3,402 – $4,650 |