| HC FLU VACCINE QS 0 5ML IM SYRINGE | 90686 | $28 |
| PBB TUBERCULOSIS SKIN TEST INTRADERMAL | 86580 | $30 |
| PBB DESTRUC BENIGNPREMALFIRST LESION | 17000 | $37 |
| PBB COLORECTAL CA SCREENINGFECALOCCULT BLOOD | 82270 | $44 |
| PBB COMPUTERIZED IMAGING OF RETINA | 92134 | $62 |
| PBB URINALYSIS AUTO WSCOPE | 81001 | $62 |
| PBB IMMUNIZ ADMIN THRU AGE 18 ANY ROUTE 1ST | 90460 | $64 |
| HC GROSS ONLY | 88300 | $67 |
| Blood Glucose Test | 82947 | $70 |
| HC CHOLESTEROL | 82465 | $82 |
| PBB OFFICE VISIT NPLEVEL 2 | 99212 | $100 |
| Office Visit (Complex) | 99214 | $100 |
| PBB NEW PATIENT AGE 1839 WITH Q0091 AND G0101 | 99395 | $100 |
| Office Visit (Established Patient) | 99213 | $100 |
| PBB OFFICE VISIT NPLEVEL 5 | 99215 | $100 |
| PBB OFFICE VISIT EPLEVEL 1 | 99211 | $100 |
| PBB NEW PATIENT AGE 4064 WITH Q0091 AND G0101 | 99396 | $100 |
| HC HPV HIGH RISK | 87624 | $109 |
| HC SPECIAL STAINS GROUP I | 88312 | $122 |
| Complete Blood Count (CBC) | 85025 | $133 |
| PBB VISUAL FIELD EXAM EXTENDED | 92083 | $137 |
| PBB IMMUNIZ ADMIN1 SINGLECOMB VACTOXOID | 90471 | $138 |
| HC HIV 12 ANTIBODY SCREEN | 86703 | $140 |
| PBB SHAVING OF EPIDERMAL OR DERMAL LESION | 11305 | $144 |
| PBB SHAVING OF EPIDERMAL LESION SINGLE | 11300 | $148 |
| Hemoglobin A1c | 83036 | $151 |
| HC SURG PATH LEVEL II | 88302 | $155 |
| PBB SHAVING OF EPIDERMAL LESION 06 TO 1 CM | 11301 | $157 |
| PBB DESTRUCTION BENIGN LESIONS 15 OR MORE | 17111 | $157 |
| PBB DESTRUCTIONWARTS UP TO 14 | 17110 | $163 |
| HC CHLAMYDIA TRACHOMATIS DNA PCR | 87491 | $164 |
| HC NEISSERIA GONORRHOEAE DNA PCR | 87591 | $164 |
| HC PSA TOTAL | 84153 | $181 |
| HC CONSULT SURGICAL N PREPARED | 88323 | $183 |
| HC SURG PATH LEVEL III | 88304 | $205 |
| HC SURG PATH LEVEL IV | 88305 | $246 |
| TSH Thyroid Test | 84443 | $263 |
| HC OR CONSULT GROSS1 FROZEN | 88331 | $275 |
| PBB EXCISION BENIGN LESION LT 05 CM | 11400 | $287 |
| HC CHEST 1 VIEW ANY | 71045 | $298 |
| Lipid Panel | 80061 | $298 |
| Therapeutic Injection | 96372 | $313 |
| Comprehensive Metabolic Panel | 80053 | $313 |
| HC PSYCH DIAGNOSTIC EVAL | 90791 | $343 |
| PBB EXCISIONSKIN TAGS UP TO INCLUDING 15 | 11200 | $346 |
| DEXA Bone Density Scan | 77080 | $360 |
| HC DEXA SCAN PERIPHER SKELETAL | 77081 | $373 |
| HC SURG PATH LEVEL V | 88307 | $380 |
| HC ER OUTPT LEVEL 1 | 99281 | $397 |
| Mammogram (Screening) | 77067 | $398 |
| Knee X-Ray | 73560 | $400 |
| Chest X-Ray (2 Views) | 71046 | $441 |
| PBB PSYCHOTHERAPY 30MIN 1634MIN | 90832 | $449 |
| PBB I D ABSCESSPARONYCHIA SIMPLE | 10060 | $476 |
| HC SHOULDER 2 VIEWS | 73030 | $525 |
| PBB RESUPERF WND BODY LT 2 5CM | 12001 | $538 |
| PBB TRABECULOPLASTY BY LASER SURGERY | 65855 | $561 |
| Head CT Scan | 70450 | $571 |
| PBB PSYCHOTHERAPY 45 MIN 3852MIN | 90834 | $631 |
| HC SURG PATH LEVEL VI | 88309 | $682 |
| PBB ARTHROCNT ASPIRINJ MAJOR JTBURSA NO US | 20610 | $699 |
| PBB EXC SKIN BENIGM LT 0 5 CM FACE | 11440 | $725 |
| HC ER OUTPT LEVEL 2 | 99282 | $726 |
| PBB HZV ZOSTER VACC RECOMBINANT ADJUVNTD IM NJX | 90750 | $728 |
| PBB IV INFUSION HYDRATION 3160 MIN | 96360 | $768 |
| PBB EXCISION BENIGN LESION 06 TO 1 CM | 11401 | $840 |
| Knee MRI | 73721 | $942 |
| Lumbar Spine MRI | 72148 | $942 |
| Cervical Spine MRI | 72141 | $942 |
| HC ER OUTPT LEVEL 3 | 99283 | $1,193 |
| Brain MRI with Contrast | 70553 | $1,574 |
| HC ER OUTPT LEVEL 4 | 99284 | $2,030 |
| Epidural Steroid Injection | 64483 | $2,136 |
| HC ER OUTPT LEVEL 5 | 99285 | $2,404 |
| HC POLYSOM ANY AGE 13 PARAM | 95808 | $3,471 |
| Echocardiogram | 93306 | $3,793 |
| PBB POLYSOM GT 6 YRS SLEEP 4 GT ADDL PARAM ATTND | 95810 | $6,641 |