| Blood Glucose Test | 82947 | $3 – $5 |
| Multiple Eyelid Cysts | 67805 | $7 – $10 |
| Eyelid Cyst Removal | 67800 | $8 – $12 |
| Hemoglobin A1c | 83036 | $18 – $26 |
| Cholesterol Test | 82465 | $20 – $28 |
| Fecal Occult Blood Test | 82270 | $25 – $36 |
| Cholesterol Panel (Lipids) | 80061 | $30 – $42 |
| HIV Test | 86703 | $36 – $51 |
| Pathology Consultation | 88323 | $38 – $54 |
| PSA (Prostate Screening) | 84153 | $40 – $56 |
| Vaccine Administration | 90471 | $42 – $59 |
| Established Patient Visit (Level 1) | 99211 | $42 – $60 |
| New Patient Visit (Level 3) | 99203 | $46 – $64 |
| Gonorrhea Test | 87591 | $52 – $74 |
| Simple Laceration Repair | 12001 | $53 – $75 |
| Thyroid Stimulating Hormone (TSH) | 84443 | $59 – $84 |
| Contact Lens Fitting | 92310 | $59 – $84 |
| Surgical Pathology (level 1) | 88300 | $72 – $102 |
| Chlamydia/Gonorrhea Test | 87491 | $79 – $112 |
| Complete Blood Count (CBC) | 85025 | $81 – $114 |
| Psychotherapy (30 min) | 90832 | $85 – $120 |
| Abscess Incision & Drainage | 10060 | $98 – $139 |
| Surgical Pathology (level 4) | 88305 | $107 – $151 |
| HPV Test | 87624 | $108 – $153 |
| Comprehensive Metabolic Panel | 80053 | $116 – $164 |
| Psychotherapy (45 min) | 90834 | $118 – $167 |
| New Patient Visit (Level 4) | 99204 | $120 – $170 |
| Urinalysis | 81001 | $125 – $177 |
| Established Patient Visit (Level 3) | 99213 | $130 – $184 |
| Established Patient Visit (Level 2) | 99212 | $130 – $184 |
| Established Patient Visit (Level 5) | 99215 | $140 – $198 |
| Eye Exam Established Patient | 92012 | $142 – $201 |
| Skin Tag Removal | 11200 | $148 – $210 |
| Therapeutic Injection | 96372 | $149 – $211 |
| Surgical Pathology (level 2) | 88302 | $151 – $214 |
| Psychotherapy (60 min) | 90837 | $159 – $224 |
| New Patient Visit (Level 2) | 99202 | $161 – $228 |
| Eye Exam New Patient | 92002 | $171 – $242 |
| Eye Exam Established (comprehensive) | 92014 | $171 – $242 |
| Eye Exam New Patient (comprehensive) | 92004 | $178 – $252 |
| Visual Field Test | 92083 | $188 – $266 |
| Shave Removal (1.1-2.0cm) | 11305 | $190 – $269 |
| Shave Removal (0.5cm or less) | 11300 | $190 – $269 |
| Established Patient Visit (Level 4) | 99214 | $195 – $276 |
| X-Ray Shoulder | 73030 | $198 – $281 |
| X-Ray Knee (2 views) | 73560 | $209 – $295 |
| Shave Removal (0.6-1.0cm) | 11301 | $220 – $311 |
| Psychiatric Evaluation | 90791 | $231 – $328 |
| Corneal Topography | 92025 | $245 – $347 |
| Special Stain | 88312 | $251 – $355 |
| Surgical Pathology (level 3) | 88304 | $253 – $358 |
| Frozen Section | 88331 | $265 – $374 |
| IV Infusion (first hour) | 96360 | $265 – $374 |
| PT Evaluation – Low Complexity | 97161 | $280 – $397 |
| TB Skin Test (PPD) | 86580 | $293 – $414 |
| PT Evaluation – Moderate Complexity | 97162 | $307 – $434 |
| PT Evaluation – High Complexity | 97163 | $337 – $477 |
| New Patient Visit (Level 5) | 99205 | $339 – $480 |
| OCT Eye Scan | 92134 | $410 – $581 |
| Bone Density Scan (DEXA) | 77080 | $414 – $586 |
| Excision Benign Lesion (0.5cm or less) | 11400 | $420 – $594 |
| Excision Benign Face Lesion (0.5cm) | 11440 | $421 – $596 |
| Bone Density Scan – Appendicular | 77081 | $423 – $598 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $443 – $627 |
| Chest X-Ray (1 view) | 71045 | $458 – $649 |
| Chest X-Ray (2 views) | 71046 | $503 – $712 |
| Surgical Pathology (level 5) | 88307 | $586 – $830 |
| Surgical Pathology (level 6) | 88309 | $603 – $853 |
| Joint Injection (large) | 20610 | $666 – $942 |
| Shingles Vaccine | 90750 | $676 – $956 |
| Destroy Wart/Lesion (up to 14) | 17110 | $705 – $998 |
| Sinus Surgery (FESS) | 31237 | $753 – $1,065 |
| Destroy Wart/Lesion (15 or more) | 17111 | $817 – $1,156 |
| Epidural Steroid Injection | 64483 | $1,029 – $1,456 |
| Echocardiogram | 93306 | $1,226 – $1,735 |
| CT Head/Brain | 70450 | $1,540 – $2,179 |
| Upper GI Endoscopy | 43235 | $2,308 – $3,266 |
| Lumbar Spine MRI | 72148 | $2,774 – $3,926 |
| MRI Knee | 73721 | $2,774 – $3,926 |
| Cervical Spine MRI | 72141 | $2,774 – $3,926 |
| Brain MRI with/without contrast | 70553 | $3,182 – $4,504 |
| Ear Tubes (Tympanostomy) | 69436 | $3,945 – $5,583 |
| Sleep Study (Limited) | 95808 | $4,324 – $6,121 |
| Myringotomy | 69420 | $4,621 – $6,540 |
| Sleep Study (Polysomnography) | 95810 | $4,963 – $7,025 |