| Surgical Pathology (level 1) | 88300 | $5 |
| Urinalysis | 81001 | $5 |
| Blood Glucose Test | 82947 | $6 |
| Surgical Pathology (level 2) | 88302 | $7 |
| Fecal Occult Blood Test | 82270 | $8 |
| TB Skin Test (PPD) | 86580 | $8 |
| Vaccine Administration | 90471 | $9 |
| X-Ray Knee (2 views) | 73560 | $9 |
| X-Ray Shoulder | 73030 | $10 |
| Complete Blood Count (CBC) | 85025 | $12 |
| Surgical Pathology (level 3) | 88304 | $12 |
| Flu Vaccine (quadrivalent) | 90686 | $15 |
| Hemoglobin A1c | 83036 | $15 |
| Chest X-Ray (1 view) | 71045 | $16 |
| Comprehensive Metabolic Panel | 80053 | $17 |
| EKG | 93000 | $18 |
| Special Stain | 88312 | $20 |
| Immunization Administration (1st vaccine) | 90460 | $20 |
| Cholesterol Panel (Lipids) | 80061 | $21 |
| Established Patient Visit (Level 1) | 99211 | $23 |
| Chest X-Ray (2 views) | 71046 | $24 |
| Thyroid Stimulating Hormone (TSH) | 84443 | $27 |
| Surgical Pathology (level 4) | 88305 | $28 |
| PSA (Prostate Screening) | 84153 | $29 |
| Therapeutic Injection | 96372 | $29 |
| Established Patient Visit (Level 2) | 99212 | $47 |
| IV Infusion (first hour) | 96360 | $50 |
| HPV Test | 87624 | $51 |
| Chlamydia/Gonorrhea Test | 87491 | $55 |
| Gonorrhea Test | 87591 | $55 |
| Frozen Section | 88331 | $63 |
| Established Patient Visit (Level 3) | 99213 | $63 |
| Joint Injection (large) | 20610 | $65 |
| PT Evaluation – Low Complexity | 97161 | $70 |
| Destroy Premalignant Lesion (1st) | 17000 | $71 |
| Echocardiogram | 93306 | $79 |
| New Patient Visit (Level 2) | 99202 | $80 |
| Surgical Pathology (level 5) | 88307 | $84 |
| Established Patient Visit (Level 5) | 99215 | $85 |
| Cholesterol Test | 82465 | $89 |
| Psychotherapy (30 min) | 90832 | $93 |
| Skin Tag Removal | 11200 | $96 |
| Simple Laceration Repair | 12001 | $98 |
| New Patient Visit (Level 5) | 99205 | $101 |
| HIV Test | 86703 | $102 |
| New Patient Visit (Level 3) | 99203 | $103 |
| Shave Removal (0.5cm or less) | 11300 | $105 |
| Shave Removal (1.1-2.0cm) | 11305 | $107 |
| Destroy Wart/Lesion (15 or more) | 17111 | $109 |
| Established Patient Visit (Level 4) | 99214 | $115 |
| Destroy Wart/Lesion (up to 14) | 17110 | $120 |
| PT Evaluation – Moderate Complexity | 97162 | $124 |
| Breast Biopsy | 19100 | $124 |
| Annual Preventive Visit Est. (18-39) | 99395 | $127 |
| Abscess Incision & Drainage | 10060 | $128 |
| Shave Removal (0.6-1.0cm) | 11301 | $129 |
| Annual Preventive Visit Est. (40-64) | 99396 | $135 |
| Excision Benign Lesion (0.5cm or less) | 11400 | $135 |
| Annual Preventive Visit (18-39) | 99385 | $141 |
| Psychotherapy (45 min) | 90834 | $142 |
| Psychiatric Evaluation | 90791 | $143 |
| Excision Benign Face Lesion (0.5cm) | 11440 | $146 |
| Surgical Pathology (level 6) | 88309 | $147 |
| Screening Mammogram | 77067 | $153 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $161 |
| Annual Preventive Visit (40-64) | 99386 | $163 |
| PT Evaluation – High Complexity | 97163 | $165 |
| Myringotomy | 69420 | $165 |
| Ear Tubes (Tympanostomy) | 69436 | $171 |
| New Patient Visit (Level 4) | 99204 | $174 |
| Pathology Consultation | 88323 | $192 |
| Psychotherapy (60 min) | 90837 | $210 |
| Tonsillectomy (Adult) | 42826 | $271 |
| Upper GI Endoscopy | 43235 | $276 |
| Sinus Surgery (FESS) | 31237 | $281 |
| Tonsillectomy (Child) | 42825 | $282 |
| Bone Density Scan (DEXA) | 77080 | $287 |
| Submucous Turbinate Resection | 30140 | $295 |
| Tonsillectomy & Adenoidectomy (Child) | 42820 | $312 |
| Tonsillectomy & Adenoidectomy (Adult) | 42821 | $323 |
| Colonoscopy (screening) | 45378 | $341 |
| Endoscopy with Biopsy | 43239 | $370 |
| Turbinate Reduction | 30130 | $404 |
| Vasectomy | 55250 | $420 |
| Colonoscopy with Biopsy | 45380 | $436 |
| Colonoscopy with Polyp Removal | 45385 | $459 |
| Laparoscopic Hernia Repair | 49650 | $468 |
| Glaucoma Laser Treatment | 65855 | $470 |
| Knee Arthroscopy (meniscus) | 29881 | $590 |
| Laparoscopic Appendectomy | 44970 | $658 |
| Septoplasty (Deviated Septum Repair) | 30520 | $659 |
| Epidural Steroid Injection | 64483 | $697 |
| Appendectomy | 44950 | $702 |
| Laparoscopic Cholecystectomy | 47562 | $720 |
| ACL Reconstruction | 29888 | $1,073 |
| Shoulder Arthroscopy | 29827 | $1,148 |
| CT Head/Brain | 70450 | $1,356 |
| MRI Knee | 73721 | $1,470 |
| Total Knee Replacement | 27447 | $1,479 |
| Total Hip Replacement | 27130 | $1,480 |
| Sleep Study (Polysomnography) | 95810 | $1,525 |
| Cervical Spine MRI | 72141 | $2,093 |
| Lumbar Spine MRI | 72148 | $2,093 |
| Brain MRI with/without contrast | 70553 | $2,566 |