| CHG SURG PATH,LEVEL II (26) | 88302 | $26 |
| CHG SURG PATH,LEVEL III (26) | 88304 | $30 |
| PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX | 90460 | $35 |
| PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID | 90471 | $35 |
| CHG SURG PATH,GROSS,LEVEL I (26) | 88300 | $35 |
| PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE | 90686 | $37 |
| BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN | 82270 | $41 |
| ASSAY, BLD/SERUM CHOLESTEROL | 82465 | $41 |
| HC ED LEVEL 5 INIT ASSESS | 99285 | $44 |
| HC ED LEVEL 1 INIT ASSESS | 99281 | $44 |
| HC ED LEVEL 3 INIT ASSESS | 99283 | $44 |
| HC ED LEVEL 2 INIT ASSESS | 99282 | $44 |
| HC ED LEVEL 4 INIT ASSESS | 99284 | $44 |
| HC AUTOM URINE DIP W MICRO | 81001 | $45 |
| CHG TB INTRADERMAL TEST | 86580 | $46 |
| Blood Glucose Test | 82947 | $46 |
| CHG SURG PATH,LEVEL IV (26) | 88305 | $47 |
| PR DESTRUC PREMALIGNANT, FIRST LESION (26) | 17000 | $50 |
| PR SHAV SKIN LES <5MM TRUNK,ARM,LEG (26) | 11300 | $50 |
| PR SHAV SKIN LES <5MM REMAINDR BODY (26) | 11305 | $52 |
| PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN (26) | 99212 | $54 |
| PR SPECIAL STAIN GROUP 1 MICROORGANISMS I&R (26) | 88312 | $54 |
| CHG RADIOLOGIC EXAM CHEST SINGLE VIEW (26) | 71045 | $54 |
| Knee X-Ray | 73560 | $57 |
| Therapeutic Injection | 96372 | $59 |
| PR SHAV SKIN LES 6-10MM TRUNK,ARM,LEG (26) | 11301 | $62 |
| CHG PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1ST SPEC (26) | 88331 | $63 |
| Chest X-Ray (2 Views) | 71046 | $66 |
| PR DESTRUCTION BENIGN LESIONS UP TO 14 (26) | 17110 | $66 |
| PR OPH SCVS MEDICAL XM&EVAL INTERMEDIATE NEW PT (26) | 92002 | $68 |
| PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES (26) | 99202 | $73 |
| Office Visit (Established Patient) | 99213 | $74 |
| PR REPR SUPERF WND BODY <2.5CM (26) | 12001 | $74 |
| DESTRUCTION BENIGN LESIONS 15 OR MORE (26) | 17111 | $80 |
| CHG X-RAY SHOULDER 2+ VW (26) | 73030 | $82 |
| Hemoglobin A1c | 83036 | $89 |
| Complete Blood Count (CBC) | 85025 | $94 |
| DEXA Bone Density Scan | 77080 | $94 |
| CHG SURG PATH,LEVEL V (26) | 88307 | $96 |
| PR PSYCHOTHERAPY W/PATIENT 30 MINUTES (26) | 90832 | $98 |
| PR ANTIBODY HIV-1&HIV-2 SINGLE RESULT | 86703 | $99 |
| PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP | 99211 | $100 |
| Office Visit (New Patient) | 99203 | $102 |
| Mammogram (Screening) | 77067 | $103 |
| PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE (26) | 10060 | $105 |
| Office Visit (Complex) | 99214 | $106 |
| PR PREVENTIVE VISIT,EST,18-39 (26) | 99395 | $112 |
| HC REF CONSULT W SLIDE PREP | 88323 | $114 |
| PR EXC SKIN BENIG <5MM FACE,FACIAL (26) | 11440 | $115 |
| PR EXC SKIN BENIG 0.6-1CM TRUNK,ARM,LEG (26) | 11401 | $115 |
| PR DEXA,BONE DENSITY,APPENDICULR SKELTN (26) | 77081 | $118 |
| PR PREVENTIVE VISIT,EST,40-64 (26) | 99396 | $118 |
| PR EXCIS CHALAZION,SINGLE (26) | 67800 | $119 |
| PR PSYCHOTHERAPY W/PATIENT 45 MINUTES (26) | 90834 | $134 |
| Comprehensive Metabolic Panel | 80053 | $134 |
| CHG PROSTATE SPECIFIC ANTIGEN,TOTAL | 84153 | $136 |
| TSH Thyroid Test | 84443 | $138 |
| PR PREVENTIVE VISIT,NEW,18-39 (26) | 99385 | $142 |
| PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN (26) | 99215 | $147 |
| PR PREVENTIVE VISIT,NEW,40-64 (26) | 99386 | $148 |
| PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15 (26) | 11200 | $150 |
| Office Visit (New, Complex) | 99204 | $154 |
| PR IV INFUSION, HYDRATION, 31-60 MIN | 96360 | $162 |
| Lipid Panel | 80061 | $175 |
| PR DRAIN/INJECT LARGE JOINT/BURSA (26) | 20610 | $178 |
| CHG CHYLMD TRACH, DNA, AMP PROBE | 87491 | $190 |
| CHG N.GONORRHOEAE, DNA, AMP PROB | 87591 | $190 |
| PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES (26) | 99205 | $200 |
| CHG IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES | 87624 | $206 |
| PR EXC SKIN BENIG <5MM TRUNK,ARM,LEG (26) | 11400 | $214 |
| PR PSYCHIATRIC DIAGNOSTIC EVALUATION (26) | 90791 | $234 |
| Psychotherapy (60 min) | 90837 | $239 |
| PR INCISION EARDRUM,ASPIR (26) | 69420 | $254 |
| EKG (Electrocardiogram) | 93000 | $272 |
| PR CREATE EARDRUM OPENING,GEN ANESTH (26) | 69436 | $290 |
| PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX | 90750 | $303 |
| PR BIOPSY OF PROSTATE,NEEDLE/PUNCH (26) | 55700 | $342 |
| PR CAUTER TURBINATE MUCOSA,SUPERFICIAL | 30801 | $390 |
| PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC (26) | 43235 | $487 |
| Upper Endoscopy with Biopsy | 43239 | $567 |
| PR BIOPSY OF BREAST, NEEDLE CORE | 19100 | $577 |
| Colonoscopy | 45378 | $646 |
| Epidural Steroid Injection | 64483 | $689 |
| Colonoscopy with Biopsy | 45380 | $771 |
| PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND (26) | 95810 | $800 |
| PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND (26) | 95808 | $812 |
| PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ (26) | 45385 | $868 |
| Echocardiogram | 93306 | $994 |
| PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX (26) | 31237 | $1,114 |
| HC SURG PAT, LEVEL-V1 | 88309 | $1,152 |
| REMOVAL OF TONSILS,<12 Y/O | 42825 | $1,240 |
| REMOVE TONSILS/ADENOIDS,<12 Y/O | 42820 | $1,286 |
| PR REMOVAL OF TONSILS,12+ Y/O | 42826 | $1,309 |
| PR REMOVE TONSILS/ADENOIDS,12+ Y/O | 42821 | $1,375 |
| Head CT Scan | 70450 | $1,930 |
| PR EXCISION TURBINATE | 30130 | $1,939 |
| PR TRANSURETHRAL ELEC-SURG PROSTATECTOM (26) | 52601 | $1,994 |
| Knee MRI | 73721 | $2,067 |
| PR CLOSED RX INTER/SUBTROCH FEMUR FX | 27238 | $2,085 |
| Cervical Spine MRI | 72141 | $2,119 |
| Lumbar Spine MRI | 72148 | $2,119 |
| PR MASTECTOMY, PARTIAL | 19301 | $2,148 |
| PR EXCISION TURBINATE,SUBMUCOUS | 30140 | $2,246 |
| PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/< | 58260 | $2,939 |
| PR APPENDECTOMY | 44950 | $3,042 |
| Brain MRI with Contrast | 70553 | $3,170 |
| PR APPENDECTOMY,RUPT APPENDX+ABSCESS | 44960 | $3,387 |
| PR MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY | 19302 | $3,432 |
| PR REPAIR OF NASAL SEPTUM | 30520 | $3,452 |
| PR MASTECTOMY, SIMPLE, COMPLETE | 19303 | $3,722 |
| Laparoscopic Cholecystectomy | 47562 | $5,470 |
| PR LAP,APPENDECTOMY | 44970 | $5,594 |
| PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG | 29881 | $5,789 |
| PR MASTECTOMY, MODIFIED RADICAL | 19307 | $6,290 |
| Total Hip Replacement | 27130 | $6,409 |
| Shoulder Arthroscopy | 29827 | $7,835 |
| PR FEMORAL FX, OPEN TX | 27236 | $8,165 |
| PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE | 55866 | $8,436 |
| PR KNEE SCOPE,AID ANT CRUCIATE REPAIR | 29888 | $10,013 |
| PR REVISE KNEE JOINT REPLACE,1 PART | 27486 | $12,354 |
| Total Knee Replacement | 27447 | $13,542 |
| PR REVISE KNEE JOINT REPLACE,ALL PARTS | 27487 | $16,234 |