| Vaccine Administration | 90471 | $14 |
| Immunization Administration (1st vaccine) | 90460 | $17 |
| Urinalysis | 81001 | $33 |
| Cholesterol Test | 82465 | $46 |
| Blood Glucose Test | 82947 | $46 |
| Hemoglobin A1c | 83036 | $59 |
| Fecal Occult Blood Test | 82270 | $67 |
| Complete Blood Count (CBC) | 85025 | $69 |
| Cholesterol Panel (Lipids) | 80061 | $71 |
| Comprehensive Metabolic Panel | 80053 | $72 |
| Chlamydia/Gonorrhea Test | 87491 | $75 |
| Gonorrhea Test | 87591 | $75 |
| Thyroid Stimulating Hormone (TSH) | 84443 | $88 |
| PSA (Prostate Screening) | 84153 | $96 |
| TB Skin Test (PPD) | 86580 | $105 |
| Psychotherapy (30 min) | 90832 | $119 |
| Surgical Pathology (level 1) | 88300 | $122 |
| HIV Test | 86703 | $129 |
| Splint Application (Long Leg) | 29505 | $165 |
| Psychotherapy (45 min) | 90834 | $168 |
| Therapeutic Injection | 96372 | $173 |
| Pathology Consultation | 88323 | $188 |
| Frozen Section | 88331 | $197 |
| Established Patient Visit (Level 2) | 99212 | $204 |
| Surgical Pathology (level 2) | 88302 | $207 |
| Elbow X-Ray (2 views) | 73070 | $216 |
| HPV Test | 87624 | $221 |
| Ankle X-Ray (2 views) | 73600 | $222 |
| Surgical Pathology (level 3) | 88304 | $225 |
| Established Patient Visit (Level 1) | 99211 | $232 |
| Wrist X-Ray (2 views) | 73100 | $232 |
| Foot X-Ray (2 views) | 73620 | $244 |
| Surgical Pathology (level 4) | 88305 | $244 |
| Hand X-Ray (2 views) | 73120 | $245 |
| New Patient Visit (Level 2) | 99202 | $247 |
| Established Patient Visit (Level 4) | 99214 | $251 |
| Established Patient Visit (Level 5) | 99215 | $251 |
| New Patient Visit (Level 3) | 99203 | $251 |
| New Patient Visit (Level 5) | 99205 | $251 |
| Established Patient Visit (Level 3) | 99213 | $251 |
| New Patient Visit (Level 4) | 99204 | $251 |
| Special Stain | 88312 | $253 |
| X-Ray Knee (2 views) | 73560 | $254 |
| Psychiatric Evaluation | 90791 | $266 |
| PT Evaluation – Low Complexity | 97161 | $266 |
| Finger X-Ray | 73140 | $276 |
| Splint Application (Short Leg) | 29515 | $282 |
| Tibia/Fibula X-Ray | 73590 | $287 |
| Psychotherapy (60 min) | 90837 | $297 |
| Chest X-Ray (1 view) | 71045 | $303 |
| Abdominal X-Ray | 74018 | $306 |
| Pelvis X-Ray | 72170 | $308 |
| Forearm X-Ray | 73090 | $322 |
| Splint Application (Short Arm) | 29125 | $326 |
| Humerus X-Ray | 73060 | $332 |
| Femur X-Ray | 73552 | $333 |
| PT Evaluation – Moderate Complexity | 97162 | $333 |
| Hand X-Ray (3+ views) | 73130 | $351 |
| Chest X-Ray (2 views) | 71046 | $358 |
| Wrist Fracture Treatment (closed) | 25600 | $363 |
| Abscess Incision & Drainage | 10060 | $363 |
| Cast Application (Forearm) | 29075 | $364 |
| Wrist X-Ray (3+ views) | 73110 | $368 |
| Lumbar Spine X-Ray | 72100 | $371 |
| Cervical Spine X-Ray | 72040 | $373 |
| Bone Density Scan – Appendicular | 77081 | $378 |
| Surgical Pathology (level 5) | 88307 | $400 |
| Foot X-Ray (3+ views) | 73630 | $400 |
| Ankle X-Ray (3+ views) | 73610 | $401 |
| PT Evaluation – High Complexity | 97163 | $402 |
| X-Ray Shoulder | 73030 | $412 |
| Elbow X-Ray (3+ views) | 73080 | $418 |
| Surgical Pathology (level 6) | 88309 | $428 |
| Simple Laceration Repair | 12001 | $429 |
| Skin Tag Removal | 11200 | $442 |
| Bone Density Scan (DEXA) | 77080 | $456 |
| Destroy Wart/Lesion (up to 14) | 17110 | $465 |
| Screening Mammogram | 77067 | $543 |
| IV Infusion (first hour) | 96360 | $551 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $575 |
| Extremity Ultrasound (complete) | 76881 | $597 |
| Joint Injection (large) | 20610 | $694 |
| Hip X-Ray | 73502 | $825 |
| CT Head/Brain | 70450 | $1,355 |
| Epidural Steroid Injection | 64483 | $1,432 |
| Echocardiogram | 93306 | $1,651 |
| Colonoscopy (screening) | 45378 | $1,993 |
| MRI Knee | 73721 | $2,598 |
| MRI Upper Extremity Joint (Shoulder/Wrist) | 73221 | $2,748 |
| MRI Lower Leg | 73718 | $2,800 |
| Lumbar Spine MRI | 72148 | $3,095 |
| Cervical Spine MRI | 72141 | $3,569 |
| Sleep Study (Polysomnography) | 95810 | $3,703 |
| MRI Lower Extremity Joint (Hip/Ankle) | 73723 | $3,810 |
| Brain MRI with/without contrast | 70553 | $4,375 |