| HC POC URINALYSIS, AUTO W/MICRO | 81001 | $2 |
| Blood Glucose Test | 82947 | $3 |
| PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID | 90460 | $5 |
| HC HIV1 & HIV2, SGL ASSAY | 86703 | $5 |
| HC OCCULT BLOOD SCREEN | 82270 | $6 |
| Hemoglobin A1c | 83036 | $7 |
| HC TB INTRADERMAL TEST | 86580 | $8 |
| HC CHOLESTEROL | 82465 | $9 |
| Complete Blood Count (CBC) | 85025 | $11 |
| TSH Thyroid Test | 84443 | $12 |
| HC PSA, TOTAL-REF LAB ONLY | 84153 | $12 |
| *HC HPV DNA HIGH RISK | 87624 | $14 |
| HC TISSUE, GROSS ONLY, LEVEL I | 88300 | $16 |
| HC OR CONSULT W/FROZ SECT/SMR 1ST | 88331 | $23 |
| HC CHLAMYDIA TRACHOMATIS RNA, TMA | 87491 | $23 |
| HC TISSUE, G & M, LEVEL II | 88302 | $32 |
| PR PSYCHOTHERAPY W/PATIENT, 30 MIN | 90832 | $36 |
| Comprehensive Metabolic Panel | 80053 | $36 |
| PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID | 90471 | $37 |
| HC TISSUE, G & M, LEVEL III | 88304 | $38 |
| HC CONSULT OUT. SLIDES W/MATERIAL | 88323 | $39 |
| Lipid Panel | 80061 | $41 |
| HC SPEC STN GRP I | 88312 | $41 |
| Therapeutic Injection | 96372 | $42 |
| HC GC BY AMPLIFIED PROBE | 87591 | $43 |
| HC LEVEL 4 GROSS & MICROSCOPIC, RB - RL | 88305 | $46 |
| HC DEXA BONE DENSITY APPEN SKEL | 77081 | $46 |
| PR PSYCHOTHERAPY W/PATIENT, 45 MIN | 90834 | $46 |
| PR DESTRUCTION(LASER SURGERY,CRYOSURGERY,CHEMOSURGERY),PREMALIGNANT LESIONS,FIRST LESION | 17000 | $47 |
| HC XRAY, CHEST, 1 VIEW | 71045 | $50 |
| Knee X-Ray | 73560 | $51 |
| HC SHOULDER ROUTINE | 73030 | $56 |
| HC OFFICE/OUTPT VISIT, EST, LEVL I | 99211 | $57 |
| HC OFFICE/OUTPT VISIT, EST, LEVL II, 10-19 MIN | 99212 | $60 |
| Chest X-Ray (2 Views) | 71046 | $61 |
| Office Visit (Established Patient) | 99213 | $63 |
| Office Visit (Complex) | 99214 | $66 |
| HC EMER ROOM LEVEL I | 99281 | $67 |
| Psychotherapy (60 min) | 90837 | $68 |
| HC OFFICE/OUTPT VISIT, EST, LEVL V, 40-54 MIN | 99215 | $69 |
| HC SIM REP S/N/A/G/TR/E <2.5CM | 12001 | $76 |
| PR REMOVAL OF SKIN TAGS, UP TO 15 | 11200 | $81 |
| HC OFFICE/OUTPT VISIT, NEW, LEVL II, 15-29 MIN | 99202 | $83 |
| PR DESTRUCTION BENIGN LESIONS UP TO 14 | 17110 | $84 |
| PR PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $85 |
| Office Visit (New Patient) | 99203 | $88 |
| HC LVL V SURG PTH | 88307 | $92 |
| Office Visit (New, Complex) | 99204 | $92 |
| HC EMER ROOM LEVEL II | 99282 | $93 |
| Mammogram (Screening) | 77067 | $94 |
| HC OFFICE/OUTPT VISIT, NEW, LEVL V, 60-74 MIN | 99205 | $97 |
| HC INCISION & DRAINAGE SINGLE | 10060 | $104 |
| DEXA Bone Density Scan | 77080 | $107 |
| HC SPATH DIAG COMP | 88309 | $126 |
| HC EMER ROOM LEVEL III | 99283 | $148 |
| PR IV INFUSION, HYDRATION, 31-60 MIN | 96360 | $151 |
| HC ARTHROCENTESIS MAJOR JOINT | 20610 | $177 |
| HC EMER ROOM LEVEL IV | 99284 | $214 |
| HC BIOPSY OF PROSTATE - NEEDLE OR PUNCH | 55700 | $246 |
| Upper Endoscopy with Biopsy | 43239 | $279 |
| HC EGD DX (INCL BRUSH/WASH) | 43235 | $279 |
| Colonoscopy | 45378 | $309 |
| HC COLON W/REMOVAL BY SNARE TECH | 45385 | $309 |
| Colonoscopy with Biopsy | 45380 | $309 |
| HC EMER ROOM LEVEL V | 99285 | $311 |
| Epidural Steroid Injection | 64483 | $313 |
| Head CT Scan | 70450 | $365 |
| Echocardiogram | 93306 | $389 |
| PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG | 11400 | $405 |
| PR BIOPSY OF BREAST, NEEDLE CORE | 19100 | $459 |
| PR POLYSOMNOGRAPHY, 4 OR MORE | 95810 | $586 |
| Lumbar Spine MRI | 72148 | $614 |
| Cervical Spine MRI | 72141 | $614 |
| Knee MRI | 73721 | $636 |
| Brain MRI with Contrast | 70553 | $1,155 |
| CREATE EARDRUM OPENING | 69436 | $1,471 |
| DESTRUCT LESION 15 OR MORE | 17111 | $1,551 |
| REMOVE TONSILS AND ADENOIDS | 42820 | $1,564 |
| REMOVAL OF TONSILS | 42826 | $1,631 |
| PR NASAL/SINUS ENDOSCOPY,BX/RMV POLYP/DEBRID | 31237 | $1,737 |
| REMOVE TONSILS AND ADENOIDS | 42821 | $1,999 |
| KNEE ARTHROSCOPY/SURGERY | 29881 | $2,539 |
| RESECT INFERIOR TURBINATE | 30140 | $3,163 |
| PROSTATECTOMY (TURP) | 52601 | $3,321 |
| Laparoscopic Cholecystectomy | 47562 | $3,937 |
| MAST SIMPLE COMPLETE | 19303 | $4,065 |
| PARTICAL MASTECTOMY | 19301 | $4,665 |
| MAST MOD RAD | 19307 | $6,362 |
| LAPAROSCOPY APPENDECTOMY | 44970 | $7,385 |
| Shoulder Arthroscopy | 29827 | $7,819 |
| TLH W/T/O 250 G OR LESS | 58571 | $8,212 |
| KNEE ARTHROSCOPY/SURGERY | 29888 | $10,210 |
| Total Hip Replacement | 27130 | $12,331 |
| Total Knee Replacement | 27447 | $12,769 |
| REVISE/REPLACE KNEE JOINT | 27486 | $16,607 |