| Tb Intradermal Test | 86580 | $5 |
| Hc Urinalysis With Micropsy | 81001 | $5 |
| Chg Radiologic Exam Chest Single View | 71045 | $8 |
| Flulaval Quadrivalent: 10 SYRINGE in 1 CARTON (19515-814-52) / .5 mL in 1 SYRINGE (19515-814-41) | 90686 | $9 |
| Chest X-Ray (2 Views) | 71046 | $9 |
| Lvl 1 Est Pt | 99211 | $11 |
| Hc Hiv - 1/2 Antibody, Rapid | 86703 | $11 |
| Contact Lens Refit Disposables | 92310 | $13 |
| Hc Occult Blood - Stool | 82270 | $16 |
| Blood Glucose Test | 82947 | $17 |
| Dual-Energy X-Ray Absorptmtry (Dxa), Bone Density Study, 1/More Sites; Appndclr Skltn (Peripheral) | 77081 | $18 |
| DEXA Bone Density Scan | 77080 | $18 |
| Knee X-Ray | 73560 | $19 |
| Self Pay, Benign Lesion Removal , 1 Large Lesion | 17110 | $20 |
| Hc Cholesterol Total Serum | 82465 | $20 |
| Refraction | 92015 | $20 |
| Therapeutic Injection | 96372 | $21 |
| Preventive, Age 40-64 Yrs, New | 99386 | $21 |
| Preventive, Age 18-39 Yrs, New | 99385 | $21 |
| X-Ray Exam Of Shoulder. 073030 | 73030 | $22 |
| Surgical Path Level 1 | 88300 | $23 |
| Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report | 92025 | $26 |
| Lvl 2 Est Pt, Straightfwd Mdm, Minimum Of 10 Minutes | 99212 | $27 |
| Complete Blood Count (CBC) | 85025 | $30 |
| Hemoglobin A1c | 83036 | $32 |
| Emerg Dept E/M Does Not Require Presence Of A Physician | 99281 | $35 |
| Cptr Ophth Dx Img Post Segmt | 92134 | $36 |
| Office Visit (Established Patient) | 99213 | $38 |
| Mammogram (Screening) | 77067 | $39 |
| Gms Group I 88312 | 88312 | $39 |
| Surgical Path Level Ii | 88302 | $40 |
| Hc Consult Ref.Material Req Slide | 88323 | $41 |
| Immunization Admin, Up To 18 Yrs, Any Route, W Counseling By Provider, Ea Vaccine | 90460 | $43 |
| Lvl 2 New Pt, Straightfwd Mdm, Minimum Of 15 Minutes | 99202 | $45 |
| Eye Exam Limited, Established Patient | 92012 | $45 |
| Eye Exam Limited, New Patient | 92002 | $45 |
| Lipid Panel | 80061 | $48 |
| Emerg Dept E/M Straightforward Mdm | 99282 | $48 |
| Level Iii Surgical Path | 88304 | $49 |
| EKG (Electrocardiogram) | 93000 | $51 |
| Destruction,Benign/Premalig Lesions, 1St Lesion | 17000 | $53 |
| Office Visit (Complex) | 99214 | $53 |
| Level Iv-Surgical Path | 88305 | $55 |
| TSH Thyroid Test | 84443 | $56 |
| Visual Field Exam, Extended | 92083 | $56 |
| Preventive, Age 18-39 Yrs, Est | 99395 | $56 |
| Immunization Admin, Single | 90471 | $56 |
| Hc Prostate Specific Antign Total | 84153 | $58 |
| Individual Psychotherapy 16-37 Minutes | 90832 | $60 |
| Preventive, Age 40-64 Yrs, Est | 99396 | $61 |
| Shaving Skin Lesion, Trunk/Arms/Legs; Diameter 0.6-1.0 Cm | 11301 | $62 |
| Removal, Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To & Incl 15 Lesions | 11200 | $65 |
| Shaving Skin Lesion, Scalp/Neck/Hands/Feet/Genitalia; Diameter 0.5 Cm/< | 11305 | $65 |
| Office Visit (New Patient) | 99203 | $69 |
| Eye Exam Comprehensive, Established Patient | 92014 | $71 |
| Zoster (Shingles) Vaccine (Rzv), Recombinant, Sub-Unit, Adjuvanted, For Intramuscular Use | 90750 | $74 |
| Arthrocentesis, Aspiration &/Or Injection; Major Joint/Bursa | 20610 | $75 |
| Emerg Dept E/M Low Mdm | 99283 | $78 |
| Hc Gc Amp Probe | 87591 | $79 |
| Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam 0.5 Cm/< | 11400 | $80 |
| Lvl 5 Est Pt, High Mdm, 40-54 Minutes | 99215 | $81 |
| Shaving Skin Lesion, Trunk/Arms/Legs; Diameter 0.5 Cm/< | 11300 | $84 |
| Office Visit (New, Complex) | 99204 | $85 |
| Hc Chlamydia Amp Probe | 87491 | $86 |
| Destruct;Benign Lesion;15+ | 17111 | $88 |
| Individual Psychotherapy 38-52 Minutes | 90834 | $91 |
| Incision & Drainage, Abscess; Simple/Single | 10060 | $91 |
| Eye Exam Comprehensive, New Patient | 92004 | $93 |
| Psychotherapy (60 min) | 90837 | $97 |
| Hc Hpv Probe | 87624 | $105 |
| Emerg Dept E/M Moderate Mdm | 99284 | $107 |
| Lvl 5 New Pt, High Mdm , 60-74 Minutes | 99205 | $109 |
| Excise, Benign Skin Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 0.5 Cm/< | 11440 | $109 |
| Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam 0.6-1.0 Cm | 11401 | $111 |
| Head CT Scan | 70450 | $111 |
| Path Consult In Surg,W Frz Sec | 88331 | $113 |
| Surg Path,Level V | 88307 | $130 |
| Psych Diagnostic Evaluation | 90791 | $131 |
| Simple Repair, Superficial Wounds, Scalp/Neck/Axillae/Genitalia/Trunk/Extremities; 2.5 Cm/< | 12001 | $131 |
| Knee MRI | 73721 | $137 |
| Excision, Chalazion; Single | 67800 | $139 |
| Cervical Spine MRI | 72141 | $141 |
| Epidural Steroid Injection | 64483 | $142 |
| Biopsy, Breast; Percut, Needle Core, Not Using Imaging Guidance (Sep Proc) | 19100 | $146 |
| Emerg Dept E/M High Mdm | 99285 | $149 |
| Lumbar Spine MRI | 72148 | $151 |
| Cauterization/Ablation, Mucosa, Turbinates, Unilat/Bilat (Sep Proc); Superficial | 30801 | $169 |
| Myringotomy W/Aspiration &/Or Eustachian Tube Inflation | 69420 | $171 |
| Biopsy, Prostate; Needle/Punch, Single/Multiple, Any Approach | 55700 | $186 |
| Surgical Path Level Vi | 88309 | $188 |
| Brain MRI with Contrast | 70553 | $197 |
| Excision, Chalazion; Multiple, Different Lids | 67805 | $271 |
| Echocardiogram | 93306 | $279 |
| Hc Hydration Iv Infusion Init | 96360 | $293 |
| Upper Gi Endoscopy; Dx, W/Wo Specimen Collection, Brushing/Washing (Sep Proc) | 43235 | $330 |
| Excision Turbinate, Partial/Complete, Any Method | 30130 | $379 |
| Upper Endoscopy with Biopsy | 43239 | $379 |
| Tympanostomy (Requiring Insertion, Ventilating Tube), General Anesthesia | 69436 | $388 |
| Polysomnogram | 95810 | $389 |
| Polysomnography; Sleep Staging | 95808 | $392 |
| Submucous Resection Turbinate, Partial/Complete, Any Method | 30140 | $429 |
| Hc Treat Femoral Fracture W/O Manip | 27238 | $461 |
| Colonoscopy | 45378 | $508 |
| Colonoscopy with Biopsy | 45380 | $544 |
| Colonoscopy, Flexible; W/Removal, Lesion, Snare | 45385 | $663 |
| Nasal/Sinus Endoscopy, Surgical; W/Biopsy, Polypectomy/Debridement (Sep Proc) | 31237 | $671 |
| Tonsillectomy, Primary/Secondary; < Age 12 | 42825 | $704 |
| Mastectomy, Partial | 19301 | $712 |
| Tonsillectomy & Adenoidectomy; < Age 12 | 42820 | $727 |
| Tonsillectomy, Primary/Secondary; Age 12+ | 42826 | $774 |
| Laparoscopy, Surgical; Appendectomy | 44970 | $861 |
| Tonsillectomy & Adenoidectomy; Age 12+ | 42821 | $943 |
| Mastectomy, Simple, Complete | 19303 | $982 |
| Trabeculoplasty, Laser Surgery, 1+ Sessions (Defined Treatment Series) | 65855 | $1,044 |
| Appendectomy; Ruptured Appendix W/Abscess/Generalized Peritonitis | 44960 | $1,131 |
| Appendectomy; | 44950 | $1,174 |
| Laparoscopic Cholecystectomy | 47562 | $1,223 |
| Arthroscopy, Knee, Surgical; W/Meniscectomy, Medial/Lateral, W/Shaving | 29881 | $1,301 |
| Mastectomy, Partial With Axillary Lymphadenectomy | 19302 | $1,539 |
| Shoulder Arthroscopy | 29827 | $1,617 |
| Total Abdominal Hysterectomy W/Wo Removal Tube(S)/Ovary(S) | 58150 | $1,661 |
| Septoplasty/Submucous Resection W/Wo Cartilage Scoring/Contouring/Graft | 30520 | $1,684 |
| Vaginal Hysterectomy, Uterus 250 Gms/< | 58260 | $1,693 |
| Mastectomy, Modified Radical | 19307 | $1,715 |
| Transurethral Electrosurgical Resection, Prostate, W/Control Postop Bleed, Complete | 52601 | $1,729 |
| Laparoscopy, Surg, W/Vaginal Hysterectomy, Uterus 250Gms/<; W/Removal, Tube(S) &/Or Ovary(S) | 58552 | $1,781 |
| Laparoscopy, Surg W Tot Hysterectomy, Uterus 250 G Or Less Remove Tube/Ovary | 58571 | $1,817 |
| Open Treatment, Femoral Fracture, Proximal End, Neck, Internal Fixation/Prosthetic Replacement | 27236 | $2,162 |
| Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation/Reconstruction | 29888 | $2,498 |
| Revision, Total Knee Arthroplasty, W/Wo Allograft; 1 Component | 27486 | $2,718 |
| Laparoscopy, Surgical Prostatectomy, Retropubic Radical, W/Nerve Sparing | 55866 | $2,912 |
| Total Knee Replacement | 27447 | $3,270 |
| Revision, Total Knee Arthroplasty; Femoral & Entire Tibial Component | 27487 | $3,560 |
| Total Hip Replacement | 27130 | $3,825 |