| OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL | 99211 | $0 |
| STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS | 82270 | $22 |
| Therapeutic Injection | 96372 | $23 |
| CHOLESTEROL LEVEL | 82465 | $23 |
| Blood Glucose Test | 82947 | $25 |
| ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT | 20610 | $30 |
| DESTRUCTION OF PRECANCER SKIN GROWTH; 1 GROWTH | 17000 | $33 |
| Hemoglobin A1c | 83036 | $36 |
| ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 10-19 MINUTES | 99212 | $38 |
| DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS | 17110 | $38 |
| URINALYSIS AUTO W/SCOPE | 81001 | $41 |
| REMOVAL OF SKIN TAG; 1-15 SKIN TAGS | 11200 | $44 |
| Comprehensive Metabolic Panel | 80053 | $44 |
| NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 15-29 MINUTES | 99202 | $49 |
| Complete Blood Count (CBC) | 85025 | $51 |
| EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY | 99282 | $65 |
| TSH Thyroid Test | 84443 | $67 |
| SURGICAL PATH GROSS | 88300 | $68 |
| Office Visit (Established Patient) | 99213 | $70 |
| SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS | 12001 | $70 |
| Lipid Panel | 80061 | $77 |
| EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD SEVERITY | 99281 | $79 |
| ANALYSIS FOR ANTIBODY TO HIV-1 AND HIV-2 VIRUS | 86703 | $85 |
| Office Visit (New Patient) | 99203 | $86 |
| DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA); AMPLIFIED PROBE TECHNIQUE | 87591 | $92 |
| ADMINISTRATION OF VACCINE | 90471 | $93 |
| PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL | 84153 | $97 |
| Office Visit (Complex) | 99214 | $103 |
| Upper Endoscopy with Biopsy | 43239 | $109 |
| SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT | 88312 | $111 |
| EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY | 99283 | $112 |
| TISSUE EXAM BY PATHOLOGIST | 88302 | $121 |
| Office Visit (New, Complex) | 99204 | $124 |
| HZV VACC RECOMBINANT IM | 90750 | $135 |
| OFFICE O/P NEW HI 60 MIN | 99205 | $144 |
| OFFICE O/P EST HI 40 MIN | 99215 | $144 |
| TISSUE EXAM BY PATHOLOGIST | 88304 | $152 |
| Colonoscopy with Biopsy | 45380 | $158 |
| X-RAY OF CHEST; 1 VIEW | 71045 | $159 |
| DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS; AMPLIFIED PROBE TECHNIQUE | 87491 | $172 |
| SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS | 10060 | $174 |
| DXA BONE DENSITY MEASUREMENT OF FOREARM; FINGER; HAND; OR FOOT | 77081 | $202 |
| Mammogram (Screening) | 77067 | $204 |
| INFUSION INTO A VEIN FOR HYDRATION; 31-60 MINUTES | 96360 | $207 |
| TISSUE EXAM BY PATHOLOGIST | 88305 | $218 |
| TB INTRADERMAL TEST | 86580 | $219 |
| Chest X-Ray (2 Views) | 71046 | $234 |
| Knee X-Ray | 73560 | $239 |
| X-RAY EXAM OF SHOULDER | 73030 | $258 |
| EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY | 99285 | $275 |
| Colonoscopy | 45378 | $290 |
| EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY | 99284 | $308 |
| REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE | 45385 | $398 |
| DEXA Bone Density Scan | 77080 | $434 |
| PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; MODERATELY HIGH COMPLEXITY | 88307 | $476 |
| TISSUE EXAM BY PATHOLOGIST | 88309 | $662 |
| REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE | 29881 | $881 |
| REMOVAL OF APPENDIX USING AN ENDOSCOPE | 44970 | $1,197 |
| EXC FACE-MM B9+MARG 0.5 CM/< | 11440 | $1,295 |
| Echocardiogram | 93306 | $1,442 |
| Head CT Scan | 70450 | $1,445 |
| REMOVAL OF NONCANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS | 11400 | $1,464 |
| Knee MRI | 73721 | $1,706 |
| Shoulder Arthroscopy | 29827 | $1,715 |
| DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | 43235 | $1,715 |
| Lumbar Spine MRI | 72148 | $2,156 |
| Cervical Spine MRI | 72141 | $2,163 |
| Brain MRI with Contrast | 70553 | $3,196 |