| Flu Vaccine (quadrivalent) | 90686 | $0 |
| Therapeutic Injection | 96372 | $0 |
| Blood Glucose Test | 82947 | $11 |
| Urinalysis | 81001 | $13 |
| Established Patient Visit (Level 4) | 99214 | $13 |
| Gonorrhea Test | 87591 | $15 |
| Fecal Occult Blood Test | 82270 | $17 |
| Cholesterol Test | 82465 | $20 |
| Complete Blood Count (CBC) | 85025 | $21 |
| Cholesterol Panel (Lipids) | 80061 | $28 |
| Hemoglobin A1c | 83036 | $28 |
| Frozen Section | 88331 | $31 |
| Comprehensive Metabolic Panel | 80053 | $33 |
| Thyroid Stimulating Hormone (TSH) | 84443 | $35 |
| Special Stain | 88312 | $37 |
| PSA (Prostate Screening) | 84153 | $39 |
| EKG | 93000 | $53 |
| Chlamydia/Gonorrhea Test | 87491 | $58 |
| HPV Test | 87624 | $64 |
| HIV Test | 86703 | $71 |
| New Patient Visit (Level 3) | 99203 | $74 |
| TB Skin Test (PPD) | 86580 | $76 |
| Vaccine Administration | 90471 | $77 |
| Surgical Pathology (level 3) | 88304 | $80 |
| Surgical Pathology (level 4) | 88305 | $96 |
| Pathology Consultation | 88323 | $104 |
| Surgical Pathology (level 1) | 88300 | $109 |
| Established Patient Visit (Level 3) | 99213 | $125 |
| Established Patient Visit (Level 5) | 99215 | $125 |
| New Patient Visit (Level 4) | 99204 | $125 |
| New Patient Visit (Level 5) | 99205 | $131 |
| Surgical Pathology (level 2) | 88302 | $132 |
| Established Patient Visit (Level 1) | 99211 | $136 |
| Established Patient Visit (Level 2) | 99212 | $136 |
| New Patient Visit (Level 2) | 99202 | $136 |
| Corneal Topography | 92025 | $141 |
| OCT Eye Scan | 92134 | $146 |
| Surgical Pathology (level 5) | 88307 | $155 |
| Psychotherapy (30 min) | 90832 | $171 |
| X-Ray Knee (2 views) | 73560 | $177 |
| Ankle X-Ray (2 views) | 73600 | $177 |
| Foot X-Ray (2 views) | 73620 | $177 |
| Abdominal X-Ray | 74018 | $177 |
| Chest X-Ray (1 view) | 71045 | $177 |
| Elbow X-Ray (2 views) | 73070 | $177 |
| Forearm X-Ray | 73090 | $177 |
| Wrist X-Ray (2 views) | 73100 | $177 |
| Finger X-Ray | 73140 | $177 |
| Tibia/Fibula X-Ray | 73590 | $177 |
| Chest X-Ray (2 views) | 71046 | $180 |
| Contact Lens Fitting | 92310 | $182 |
| Femur X-Ray | 73552 | $188 |
| Humerus X-Ray | 73060 | $193 |
| Hand X-Ray (3+ views) | 73130 | $204 |
| Foot X-Ray (3+ views) | 73630 | $204 |
| Ankle X-Ray (3+ views) | 73610 | $204 |
| Cervical Spine X-Ray | 72040 | $207 |
| Visual Field Test | 92083 | $208 |
| Wrist X-Ray (3+ views) | 73110 | $208 |
| Shave Removal (0.6-1.0cm) | 11301 | $209 |
| X-Ray Shoulder | 73030 | $210 |
| Shave Removal (1.1-2.0cm) | 11305 | $210 |
| Elbow X-Ray (3+ views) | 73080 | $211 |
| Destroy Wart/Lesion (15 or more) | 17111 | $212 |
| Hand X-Ray (2 views) | 73120 | $214 |
| Pelvis X-Ray | 72170 | $214 |
| Lumbar Spine X-Ray | 72100 | $214 |
| Bone Density Scan – Appendicular | 77081 | $219 |
| Destroy Wart/Lesion (up to 14) | 17110 | $220 |
| Destroy Premalignant Lesion (1st) | 17000 | $220 |
| Skin Tag Removal | 11200 | $220 |
| Simple Laceration Repair | 12001 | $225 |
| Psychotherapy (45 min) | 90834 | $228 |
| Bone Density Scan (DEXA) | 77080 | $263 |
| Screening Mammogram | 77067 | $285 |
| Cast Application (Forearm) | 29075 | $286 |
| Extremity Ultrasound (complete) | 76881 | $293 |
| Psychotherapy (60 min) | 90837 | $301 |
| Shingles Vaccine | 90750 | $302 |
| Wrist Fracture Treatment (closed) | 25600 | $304 |
| PT Evaluation – Low Complexity | 97161 | $311 |
| Surgical Pathology (level 6) | 88309 | $322 |
| Abscess Incision & Drainage | 10060 | $329 |
| Splint Application (Short Arm) | 29125 | $387 |
| Psychiatric Evaluation | 90791 | $388 |
| Eyelid Cyst Removal | 67800 | $389 |
| Hip X-Ray | 73502 | $412 |
| Splint Application (Short Leg) | 29515 | $412 |
| PT Evaluation – Moderate Complexity | 97162 | $421 |
| Myringotomy | 69420 | $426 |
| Shave Removal (0.5cm or less) | 11300 | $438 |
| Multiple Eyelid Cysts | 67805 | $488 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $496 |
| IV Infusion (first hour) | 96360 | $511 |
| PT Evaluation – High Complexity | 97163 | $520 |
| Joint Injection (large) | 20610 | $548 |
| Splint Application (Long Leg) | 29505 | $571 |
| Glaucoma Laser Treatment | 65855 | $600 |
| Excision Benign Face Lesion (0.5cm) | 11440 | $698 |
| Excision Benign Lesion (0.5cm or less) | 11400 | $699 |
| CT Head/Brain | 70450 | $761 |
| Epidural Steroid Injection | 64483 | $1,108 |
| Echocardiogram | 93306 | $1,279 |
| MRI Knee | 73721 | $1,304 |
| Upper GI Endoscopy | 43235 | $1,374 |
| MRI Upper Extremity Joint (Shoulder/Wrist) | 73221 | $1,398 |
| MRI Lower Leg | 73718 | $1,408 |
| Turbinate Ablation | 30801 | $1,541 |
| Lumbar Spine MRI | 72148 | $1,561 |
| Endoscopy with Biopsy | 43239 | $1,585 |
| Cervical Spine MRI | 72141 | $1,781 |
| Vasectomy | 55250 | $1,903 |
| MRI Lower Extremity Joint (Hip/Ankle) | 73723 | $1,930 |
| Sinus Surgery (FESS) | 31237 | $1,969 |
| Breast Biopsy | 19100 | $2,036 |
| Colonoscopy (screening) | 45378 | $2,071 |
| Colonoscopy with Biopsy | 45380 | $2,094 |
| Brain MRI with/without contrast | 70553 | $2,174 |
| Colonoscopy with Polyp Removal | 45385 | $2,393 |
| Sleep Study (Limited) | 95808 | $2,424 |
| Sleep Study (Polysomnography) | 95810 | $2,839 |
| Submucous Turbinate Resection | 30140 | $3,917 |
| Septoplasty (Deviated Septum Repair) | 30520 | $3,917 |
| Turbinate Reduction | 30130 | $3,917 |