| Surgical Pathology (level 1) | 88300 | $11 |
| Total Hip Replacement | 27130 | $12 – $41,457 |
| Immunization Administration (1st vaccine) | 90460 | $13 – $58 |
| Vaccine Administration | 90471 | $13 – $222 |
| Flu Vaccine (quadrivalent) | 90686 | $15 – $56 |
| Urinalysis | 81001 | $16 – $25 |
| Surgical Pathology (level 2) | 88302 | $17 |
| Established Patient Visit (Level 1) | 99211 | $18 |
| Chest X-Ray (1 view) | 71045 | $19 – $62 |
| TB Skin Test (PPD) | 86580 | $21 – $94 |
| Cholesterol Test | 82465 | $24 – $33 |
| Blood Glucose Test | 82947 | $25 – $39 |
| Surgical Pathology (level 3) | 88304 | $29 |
| Fecal Occult Blood Test | 82270 | $29 – $45 |
| Annual Preventive Visit Est. (18-39) | 99395 | $30 – $175 |
| X-Ray Knee (2 views) | 73560 | $32 – $115 |
| Therapeutic Injection | 96372 | $32 |
| Cholesterol Panel (Lipids) | 80061 | $33 – $52 |
| Hemoglobin A1c | 83036 | $34 – $53 |
| X-Ray Shoulder | 73030 | $36 – $108 |
| Complete Blood Count (CBC) | 85025 | $39 – $60 |
| Chest X-Ray (2 views) | 71046 | $40 – $72 |
| Upper GI Endoscopy | 43235 | $43 – $240 |
| OCT Eye Scan | 92134 | $45 – $193 |
| Comprehensive Metabolic Panel | 80053 | $45 – $69 |
| PSA (Prostate Screening) | 84153 | $47 – $75 |
| Shave Removal (0.5cm or less) | 11300 | $56 – $256 |
| Simple Laceration Repair | 12001 | $62 – $9,545 |
| Skin Tag Removal | 11200 | $62 – $9,545 |
| Thyroid Stimulating Hormone (TSH) | 84443 | $62 – $100 |
| Special Stain | 88312 | $68 |
| Established Patient Visit (Level 2) | 99212 | $78 |
| Screening Mammogram | 77067 | $79 |
| Annual Preventive Visit Est. (40-64) | 99396 | $83 – $185 |
| Gonorrhea Test | 87591 | $83 – $137 |
| Chlamydia/Gonorrhea Test | 87491 | $83 – $138 |
| Annual Preventive Visit (18-39) | 99385 | $85 – $193 |
| Annual Preventive Visit (40-64) | 99386 | $86 – $223 |
| Surgical Pathology (level 4) | 88305 | $96 |
| Visual Field Test | 92083 | $98 – $402 |
| Destroy Premalignant Lesion (1st) | 17000 | $99 – $9,545 |
| Psychotherapy (30 min) | 90832 | $106 – $502 |
| New Patient Visit (Level 2) | 99202 | $112 |
| Shingles Vaccine | 90750 | $114 |
| Bone Density Scan – Appendicular | 77081 | $117 – $499 |
| HPV Test | 87624 | $119 – $183 |
| Psychotherapy (45 min) | 90834 | $120 – $502 |
| Psychiatric Evaluation | 90791 | $125 – $144 |
| Frozen Section | 88331 | $133 – $538 |
| Destroy Wart/Lesion (up to 14) | 17110 | $139 – $9,545 |
| Shave Removal (1.1-2.0cm) | 11305 | $140 – $9,545 |
| Psychotherapy (60 min) | 90837 | $144 – $502 |
| Established Patient Visit (Level 3) | 99213 | $146 |
| Laparoscopic Hernia Repair | 49650 | $154 – $277 |
| Shave Removal (0.6-1.0cm) | 11301 | $154 – $9,545 |
| Destroy Wart/Lesion (15 or more) | 17111 | $163 – $9,545 |
| PT Evaluation – Low Complexity | 97161 | $172 – $300 |
| Shoulder Arthroscopy | 29827 | $180 |
| New Patient Visit (Level 3) | 99203 | $181 |
| PT Evaluation – Moderate Complexity | 97162 | $188 – $300 |
| Knee Arthroscopy (meniscus) | 29881 | $195 |
| Abscess Incision & Drainage | 10060 | $200 – $9,545 |
| PT Evaluation – High Complexity | 97163 | $204 – $314 |
| Surgical Pathology (level 5) | 88307 | $210 |
| Laparoscopic Appendectomy | 44970 | $212 – $1,192 |
| Established Patient Visit (Level 4) | 99214 | $216 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $218 – $10,350 |
| Excision Benign Face Lesion (0.5cm) | 11440 | $218 – $10,350 |
| Excision Benign Lesion (0.5cm or less) | 11400 | $218 – $10,350 |
| Appendectomy | 44950 | $224 |
| Echocardiogram | 93306 | $228 |
| Laparoscopic Cholecystectomy | 47562 | $232 – $1,306 |
| Myringotomy | 69420 | $252 – $10,350 |
| Joint Injection (large) | 20610 | $270 – $486 |
| Bone Density Scan (DEXA) | 77080 | $278 – $603 |
| Sleep Study (Polysomnography) | 95810 | $292 |
| Endoscopy with Biopsy | 43239 | $301 |
| Established Patient Visit (Level 5) | 99215 | $320 |
| ACL Reconstruction | 29888 | $344 |
| New Patient Visit (Level 4) | 99204 | $360 |
| Surgical Pathology (level 6) | 88309 | $369 |
| New Patient Visit (Level 5) | 99205 | $401 |
| Total Knee Replacement | 27447 | $451 – $5,078 |
| Epidural Steroid Injection | 64483 | $470 – $846 |
| Ear Tubes (Tympanostomy) | 69436 | $479 – $1,027 |
| Turbinate Ablation | 30801 | $512 |
| Colonoscopy with Polyp Removal | 45385 | $551 |
| Sinus Surgery (FESS) | 31237 | $559 – $12,650 |
| IV Infusion (first hour) | 96360 | $564 – $868 |
| Colonoscopy (screening) | 45378 | $739 |
| Colonoscopy with Biopsy | 45380 | $768 |
| Tonsillectomy (Child) | 42825 | $1,010 |
| Tonsillectomy (Adult) | 42826 | $1,018 |
| CT Head/Brain | 70450 | $1,085 – $3,900 |
| Tonsillectomy & Adenoidectomy (Child) | 42820 | $1,120 |
| Submucous Turbinate Resection | 30140 | $1,128 – $2,236 |
| Tonsillectomy & Adenoidectomy (Adult) | 42821 | $1,215 |
| Turbinate Reduction | 30130 | $1,404 – $2,527 |
| MRI Knee | 73721 | $1,494 – $3,900 |
| Lumbar Spine MRI | 72148 | $1,535 – $3,900 |
| Cervical Spine MRI | 72141 | $1,593 – $3,900 |
| Septoplasty (Deviated Septum Repair) | 30520 | $2,227 |
| Brain MRI with/without contrast | 70553 | $2,508 – $3,900 |