| OFF/OP EST MAY X REQ PHY/QHP | 99211 | $6 |
| IIV4 VACC NO PRSV 0.5 ML IM | 90686 | $8 |
| TB INTRADERMAL TEST | 86580 | $9 |
| CHOLESTEROL LEVEL | 82465 | $12 |
| IMMUNIZATION ADMIN | 90471 | $12 |
| Complete Blood Count (CBC) | 85025 | $15 |
| OCCULT BLOOD FECES | 82270 | $15 |
| OFFICE O/P EST SF 10 MIN | 99212 | $17 |
| Therapeutic Injection | 96372 | $18 |
| Blood Glucose Test | 82947 | $20 |
| Hemoglobin A1c | 83036 | $28 |
| MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED | 81001 | $29 |
| OFFICE O/P NEW SF 15 MIN | 99202 | $32 |
| Office Visit (Established Patient) | 99213 | $33 |
| EMR DPT VST MAYX REQ PHY/QHP | 99281 | $37 |
| EMERGENCY DEPT VISIT SF MDM | 99282 | $39 |
| PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; LIMITED EXAMINATION | 88300 | $39 |
| Lipid Panel | 80061 | $41 |
| DRAIN/INJ JOINT/BURSA W/O US | 20610 | $43 |
| DEXA Bone Density Scan | 77080 | $44 |
| PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL | 84153 | $47 |
| TSH Thyroid Test | 84443 | $48 |
| Office Visit (New Patient) | 99203 | $50 |
| Office Visit (Complex) | 99214 | $51 |
| SHAVE SKIN LESION 0.6-1.0 CM | 11301 | $52 |
| DESTRUCT PREMALG LESION | 17000 | $52 |
| DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS; AMPLIFIED PROBE TECHNIQUE | 87491 | $52 |
| SPECIAL STAINS GROUP 1 | 88312 | $53 |
| DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA); AMPLIFIED PROBE TECHNIQUE | 87591 | $59 |
| PSYCHOTHERAPY; 30 MINUTES | 90832 | $64 |
| PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE | 88302 | $64 |
| EMERGENCY DEPT VISIT LOW MDM | 99283 | $70 |
| OFFICE O/P EST HI 40 MIN | 99215 | $72 |
| I&D ABSCESS SIMPLE/SINGLE | 10060 | $72 |
| PSYCHOTHERAPY; 45 MINUTES | 90834 | $75 |
| REMOVAL OF SKIN TAG; 1-15 SKIN TAGS | 11200 | $81 |
| Psychotherapy (60 min) | 90837 | $82 |
| Office Visit (New, Complex) | 99204 | $84 |
| SHAVE SKIN LESION 0.5 CM/< | 11300 | $97 |
| X-RAY OF CHEST; 1 VIEW | 71045 | $97 |
| PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; MODERATELY LOW COMPLEXITY | 88304 | $98 |
| Comprehensive Metabolic Panel | 80053 | $99 |
| PATHOLOGY EXAMINATION OF SPECIMEN DURING SURGERY; FIRST TISSUE BLOCK | 88331 | $105 |
| PSYCH DIAGNOSTIC EVALUATION | 90791 | $106 |
| OFFICE O/P NEW HI 60 MIN | 99205 | $109 |
| Knee X-Ray | 73560 | $111 |
| CONSLTJ&REPRT MATRL PREP SLD | 88323 | $112 |
| EMERGENCY DEPT VISIT MOD MDM | 99284 | $113 |
| Mammogram (Screening) | 77067 | $114 |
| Chest X-Ray (2 Views) | 71046 | $118 |
| PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; INTERMEDIATE COMPLEXITY | 88305 | $121 |
| X-RAY EXAM OF SHOULDER | 73030 | $123 |
| Shingrix | 90750 | $131 |
| INFUSION INTO A VEIN FOR HYDRATION; 31-60 MINUTES | 96360 | $145 |
| REMOVAL OF NONCANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS | 11400 | $170 |
| EMERGENCY DEPT VISIT HI MDM | 99285 | $171 |
| PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; MODERATELY HIGH COMPLEXITY | 88307 | $211 |
| PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; HIGH COMPLEXITY | 88309 | $368 |
| Head CT Scan | 70450 | $636 |
| Knee MRI | 73721 | $789 |
| Lumbar Spine MRI | 72148 | $847 |
| Epidural Steroid Injection | 64483 | $872 |
| Cervical Spine MRI | 72141 | $879 |
| POLYSOM 6/> YRS 4/> PARAM | 95810 | $1,066 |
| Echocardiogram | 93306 | $1,124 |
| Brain MRI with Contrast | 70553 | $1,159 |