| IIV4 VA NO PRSV (FLUZONE QUAD) | 90686 | $12 |
| IMM ADM ONE VAC SGL/COMB | 90471 | $12 |
| P CLINIC VISIT EST 99211 | 99211 | $16 |
| HEMOCCULT | 82270 | $20 |
| SKIN TEST PPD | 86580 | $22 |
| DEST PRE-MALIGNANT LES 1ST | 17000 | $34 |
| CHOLESTRL SERUM WHOLE BL P9445 | 82465 | $40 |
| Therapeutic Injection | 96372 | $40 |
| REMOVAL OF SKIN TAGS UP TO 15 | 11200 | $43 |
| CLINIC VISIT EST 99212 | 99212 | $43 |
| ARTHRO ASP/INJ LG JT WO/US | 20610 | $46 |
| P ACUITY LEVEL 1 | 99281 | $48 |
| LEVEL I GROSS EXAM | 88300 | $48 |
| Office Visit (Established Patient) | 99213 | $48 |
| CLINIC VISIT NEW 99202 | 99202 | $48 |
| DESTR BENIGN LESIONS 1-14 | 17110 | $50 |
| Blood Glucose Test | 82947 | $52 |
| Office Visit (Complex) | 99214 | $52 |
| BIOPSY SKIN 1 LESION | 11100 | $53 |
| Office Visit (New Patient) | 99203 | $56 |
| ID SIMPLE ABSCESS | 10060 | $60 |
| P SHAV DERM LES TRNK<0.5CM | 11300 | $62 |
| DEST BENIGN LES CHEM TCA GT 14 | 17111 | $68 |
| CLINIC VISIT EST 99215 | 99215 | $70 |
| P SHAV DER LES SCLP <0.5CM | 11305 | $70 |
| URINALYSIS R & M | 81001 | $70 |
| Office Visit (New, Complex) | 99204 | $80 |
| CLINIC VISIT NEW 99205 | 99205 | $88 |
| P SHAV DER LES TRK 0.6-1.0CM | 11301 | $94 |
| Complete Blood Count (CBC) | 85025 | $95 |
| PREV VISIT EST AGE 18-39 | 99395 | $97 |
| P ACUITY LEVEL 2 | 99282 | $98 |
| PSYCHOTHERAPY 30 MINUTES | 90832 | $106 |
| PSYCHOTHERAPY 45 MINUTES | 90834 | $106 |
| Psychotherapy (60 min) | 90837 | $106 |
| PREV VISIT NEW AGE 18-39 | 99385 | $115 |
| P ACUITY LEVEL 3 | 99283 | $122 |
| P BX BRST PERC NDL CRE WO/IMAG | 19100 | $127 |
| DEXA APPEND SKEL PERIPHERAL | 77081 | $127 |
| P EX BEN LES<0.5CM TRNK/LIMB | 11400 | $142 |
| SHINGRIX VACCINE INJ | 90750 | $150 |
| PSYCH DIAGNOSTIC EVAL | 90791 | $151 |
| Hemoglobin A1c | 83036 | $158 |
| SPECIAL STAIN GROUP 1 | 88312 | $161 |
| P PRVNT VST EST 40-64 YRS | 99396 | $170 |
| CHEST 1 VIEW | 71045 | $175 |
| P EXC BGN LES FEENL <0.5CM | 11440 | $179 |
| P EXC LES B T A L 0.6-1.0CM | 11401 | $183 |
| LEVEL 2 GROSS & MICRO EXAM | 88302 | $189 |
| TOTAL PSA PNL 2770 | 84153 | $198 |
| P ACUITY LEVEL 5 | 99285 | $208 |
| P PRVNT VST NEW 40-64 YRS | 99386 | $209 |
| LEVEL 3 GROSS & MICRO EXAM | 88304 | $212 |
| P ACUITY LEVEL 4 | 99284 | $214 |
| Comprehensive Metabolic Panel | 80053 | $215 |
| TSH Thyroid Test | 84443 | $222 |
| HPV HIGH RISK TYPES | 87624 | $222 |
| Mammogram (Screening) | 77067 | $226 |
| Lipid Panel | 80061 | $228 |
| P BX PROST NDL/PNCH SGL/MULT | 55700 | $235 |
| UND 18 IMM ADMIN 1ST/ONLY COM | 90460 | $235 |
| LEVEL 4 GROSS & MICRO EXAM | 88305 | $250 |
| DEXA Bone Density Scan | 77080 | $252 |
| CHYLMD TRACH DNA AMP PR P4792 | 87491 | $276 |
| NEISSRIA GONOR AMP PROBE P9292 | 87591 | $276 |
| OR CONSULT FROZ SEC SGL SPEC | 88331 | $276 |
| SHOULDER MIN 2 VIEWS | 73030 | $307 |
| Colonoscopy with Biopsy | 45380 | $363 |
| LEVEL 5 GROSS & MICRO EXAM | 88307 | $408 |
| Chest X-Ray (2 Views) | 71046 | $580 |
| SMPL LAC RPR 0-2.5CM SCALP | 12001 | $590 |
| Knee X-Ray | 73560 | $608 |
| LEVEL 6 GROSS & MICRO EXAM | 88309 | $619 |
| PATHOLOGY CONSULT | 88323 | $737 |
| IV INF HYDRATION 1ST HR | 96360 | $795 |
| P CL TX I/P/S TROCHAN FX WO | 27238 | $829 |
| Colonoscopy | 45378 | $1,575 |
| Head CT Scan | 70450 | $1,603 |
| Echocardiogram | 93306 | $2,265 |
| Cervical Spine MRI | 72141 | $2,424 |
| Knee MRI | 73721 | $2,514 |
| Lumbar Spine MRI | 72148 | $2,514 |
| Total Hip Replacement | 27130 | $2,738 |
| COLONOSCOPY W/SNARE TECHNIQUE | 45385 | $3,253 |
| Upper Endoscopy with Biopsy | 43239 | $3,526 |
| EGD W/WO BRUSHINGS | 43235 | $3,526 |
| Brain MRI with Contrast | 70553 | $3,804 |
| PSG 9+PARAM ATTENDED <6 HRS | 95810 | $5,467 |
| MYRINGOTOMY W TUBE UNILATERAL | 69436 | $7,127 |