| TUBERCULIN (PPD) INJ 5UNITS/0.1 ML | 86580 | $11 |
| ONC COLON CANCER SCREEN | 82270 | $14 |
| ELD ADM SINGLE IMMUNIZATION | 90471 | $17 |
| SH SK LES-TRK/ARM/LEG TO 0.5CM | 11300 | $23 |
| SHAVE LES;SCALP,NECK,EXT .5CM> | 11305 | $25 |
| Blood Glucose Test | 82947 | $31 |
| CHOLESTEROL - LC SCREENING | 82465 | $34 |
| ASPIRATION/INJ JT BURSA-MAJOR | 20610 | $34 |
| URINE FOR KEOTONES | 81001 | $34 |
| SHAVING LESION - TRUNK/ARM/LEG | 11301 | $35 |
| DESTRUCTION-BEN LESION 1 | 17000 | $35 |
| BIOPSY OF SKIN, SINGLE LESION | 11100 | $35 |
| Therapeutic Injection | 96372 | $37 |
| REMOVE SKIN TAGS UP TO 15 | 11200 | $41 |
| Complete Blood Count (CBC) | 85025 | $43 |
| EXC BENIGN LESION; 0.5 CM OR < | 11400 | $44 |
| ED LEVEL I | 99281 | $50 |
| DESTRUCTION-FLAT WARTS 1-14 | 17110 | $52 |
| EKG (Electrocardiogram) | 93000 | $52 |
| INCISION/DRAINAGE OF ABSCESS | 10060 | $53 |
| ESTAB PT OFFICE VISIT; LEVEL 1 | 99211 | $53 |
| TISSUE GROSS ONLY-T LEV I | 88300 | $53 |
| EXC OTHER BENIGN LES 0.5 < | 11440 | $56 |
| SIMPLE REPAIR; 2.5 CM OR LESS | 12001 | $61 |
| EXC BENIGN LESION 0.6-1.0 CM | 11401 | $62 |
| MYRINGOTOMY INC ASP/EUS TUBE I | 69420 | $68 |
| ED;EXPANDED | 99282 | $70 |
| ESTAB PT OFFICE VISIT; LEVEL 2 | 99212 | $73 |
| Hemoglobin A1c | 83036 | $75 |
| TSH Thyroid Test | 84443 | $79 |
| BX BREAST;PERCUT, NEEDLE CORE | 19100 | $82 |
| Office Visit (Established Patient) | 99213 | $96 |
| Lipid Panel | 80061 | $98 |
| Comprehensive Metabolic Panel | 80053 | $101 |
| CHEST 1 VIEW | 71045 | $103 |
| FS-TECH | 88331 | $104 |
| DEXA FOREARM | 77081 | $104 |
| NEW PT OFFICE VISIT; LEVEL 2 | 99202 | $105 |
| TISSUE GROSS MICRO-T LEV II | 88302 | $110 |
| Knee X-Ray | 73560 | $119 |
| SINUS DEBRIDGMENT WITH ENDO | 31237 | $119 |
| DESTRUCTION-FLAT WARTS 15+ | 17111 | $122 |
| Epidural Steroid Injection | 64483 | $123 |
| PSA TOTAL | 84153 | $125 |
| ED IV HYDRATION 31-60 MIN | 96360 | $128 |
| TISSUE GROSS MICRO-T LEV III | 88304 | $133 |
| EMERGENCY DEPARTMENT LEVEL 3 | 99283 | $134 |
| Office Visit (Complex) | 99214 | $143 |
| Office Visit (New Patient) | 99203 | $143 |
| SHOULDER | 73030 | $145 |
| Chest X-Ray (2 Views) | 71046 | $151 |
| NEISSERIA GONORRHOEAE;PROBE | 87591 | $161 |
| CHLAMYDIA TRACHOMATIS;PROBE | 87491 | $161 |
| TISSUE GROSS MICRO-T LEV IV | 88305 | $169 |
| CONSULT MATL REQ SLIDE PREP | 88323 | $176 |
| E/M EP LEVEL V | 99215 | $192 |
| SPECIAL STAINS GROUP 1 | 88312 | $221 |
| Office Visit (New, Complex) | 99204 | $225 |
| ED;COMPREHENSIVE | 99284 | $226 |
| VARICELLA-ZOSTER GE/AS01B-PF 50MCG/0.5 ML KIT | 90750 | $270 |
| NEW PT OFFICE VISIT; LEVEL 5 | 99205 | $289 |
| TYMPANOSTOMY (REQ VENT TUBE) | 69436 | $307 |
| HPV HUMAN AMPLIFIED PROBE | 87624 | $311 |
| ED LEVEL V | 99285 | $331 |
| DEXA Bone Density Scan | 77080 | $352 |
| Mammogram (Screening) | 77067 | $381 |
| BIOPSY,PROSTATE;NEEDLE/PUNCH | 55700 | $428 |
| TONSILLECTOMY PRIM OVER AGE 12 | 42826 | $461 |
| TONSIL W/ADENOID OVER AGE 12 | 42821 | $559 |
| TISSUE GROSS MICRO-T LEV V | 88307 | $572 |
| Colonoscopy | 45378 | $609 |
| Upper Endoscopy with Biopsy | 43239 | $637 |
| EXCISIO TURBINATE PARTIAL/COMP | 30130 | $650 |
| SUBMUCOUS RESECTION TURB,PAR/C | 30140 | $710 |
| Colonoscopy with Biopsy | 45380 | $727 |
| Head CT Scan | 70450 | $753 |
| LAPAROSCOPY,SURG APPENDECTOMY | 44970 | $805 |
| TISSUE GROSS MICRO-T LEV VI | 88309 | $811 |
| Echocardiogram | 93306 | $837 |
| COLONOSCOPY W/REMOVAL BY SNARE | 45385 | $863 |
| ENDOSCOPY UPPER GI COMPLEX DI | 43235 | $878 |
| APPENDECTOMY | 44950 | $902 |
| Knee MRI | 73721 | $967 |
| Cervical Spine MRI | 72141 | $982 |
| SEPTOPLASTY | 30520 | $990 |
| Laparoscopic Cholecystectomy | 47562 | $1,010 |
| Lumbar Spine MRI | 72148 | $1,032 |
| MASTECTOMY PARTIAL | 19301 | $1,033 |
| APPENDECTOMY RUPT W/ABSCESS OR | 44960 | $1,112 |
| TRANSURETHRAL ELECTRO RESECT | 52601 | $1,375 |
| VAGINAL HYSTERECTOMY | 58260 | $1,529 |
| MASTECTOMY PTL W/AX LYMPHADEN | 19302 | $1,531 |
| MASTECTOMY SIMPLE COMPLETE | 19303 | $1,554 |
| OPEN TRMT OF FEMORAL FRACTURE | 27236 | $1,622 |
| ARTHRO;KNEE-MED/LAT MENISCE | 29881 | $1,639 |
| LAPAROSCP SURG W/TOTL HYSTEREC | 58571 | $1,817 |
| HYSTERECTOMY TOTAL ABDOMINAL | 58150 | $1,823 |
| Brain MRI with Contrast | 70553 | $1,910 |
| MASTECTOMY MODIFIED;RADICAL | 19307 | $1,968 |
| Shoulder Arthroscopy | 29827 | $2,174 |
| REVISION TKR-ONE COMPONENT | 27486 | $2,658 |
| ARTHRO;KNEE-ACL RECONSTRUCTION | 29888 | $2,967 |
| Total Knee Replacement | 27447 | $3,272 |
| REVISION TOTAL KNEE-BOTH COMPN | 27487 | $3,401 |
| Total Hip Replacement | 27130 | $3,477 |