| Therapeutic Injection | 96372 | $2 |
| OFF/OP EST MAY X REQ PHY/QHP | 99211 | $25 |
| HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | 82465 | $26 |
| Blood Glucose Test | 82947 | $31 |
| EMR DPT VST MAYX REQ PHY/QHP | 99281 | $45 |
| Complete Blood Count (CBC) | 85025 | $47 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | 82270 | $66 |
| Hemoglobin A1c | 83036 | $81 |
| HC IMADM PRQ ID SUBQ/IM NJXS 1 VACCINE - GENERAL VACCINE | 90471 | $85 |
| OFFICE O/P EST SF 10 MIN | 99212 | $90 |
| EXTENDED VISUAL FIELD XM | 92083 | $96 |
| HC SQ, PSA, POST PROSTATECTOMY | 84153 | $97 |
| TSH Thyroid Test | 84443 | $101 |
| Lipid Panel | 80061 | $109 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $117 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ CHLAMYOIA, DNA | 87491 | $117 |
| HC HPV HIGH RISK | 87624 | $117 |
| OFFICE O/P NEW SF 15 MIN | 99202 | $120 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY SURG PATH | 88300 | $129 |
| HC OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT | 92002 | $135 |
| HC OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT | 92012 | $135 |
| ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR | 90750 | $152 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R SP STAIN GRP1-K | 88312 | $153 |
| EMERGENCY DEPT VISIT SF MDM | 99282 | $155 |
| HC OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST | 92004 | $158 |
| HC PSYCHIATRIC DIAGNOSTIC EVALUATION - SYSTEM | 90791 | $163 |
| HC PSYCHOTHERAPY W/PT 30 MIN - SYSTEM | 90832 | $163 |
| Office Visit (Established Patient) | 99213 | $170 |
| Office Visit (Complex) | 99214 | $186 |
| HC OFFICE OUTPATIENT 40 MINUTES - SYSTEM | 99215 | $189 |
| HC DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL | 77081 | $195 |
| HC OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/> | 92014 | $198 |
| HC DESTRUCTION PREMALIGNANT LESION 1ST | 17000 | $201 |
| Office Visit (New Patient) | 99203 | $205 |
| HC PSYCHOTHERAPY W/PT 45 MIN - SYSTEM | 90834 | $214 |
| Psychotherapy (60 min) | 90837 | $219 |
| PREV VISIT EST AGE 18-39 | 99395 | $225 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 88302 | $241 |
| DRAIN/INJ JOINT/BURSA W/O US | 20610 | $245 |
| DEXA Bone Density Scan | 77080 | $258 |
| EMERGENCY DEPT VISIT LOW MDM | 99283 | $260 |
| PREV VISIT NEW AGE 18-39 | 99385 | $275 |
| Echocardiogram | 93306 | $278 |
| HC CHEST SINGLE VIEW, RADIOLOGIC EXAMINATION | 71045 | $285 |
| Knee X-Ray | 73560 | $300 |
| Office Visit (New, Complex) | 99204 | $330 |
| Chest X-Ray (2 Views) | 71046 | $374 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 88305 | $382 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 88304 | $382 |
| HC RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS | 73030 | $383 |
| Comprehensive Metabolic Panel | 80053 | $408 |
| RMVL SKIN TAGS UP TOINC 15 | 11200 | $415 |
| HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | 10060 | $416 |
| Mammogram (Screening) | 77067 | $430 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC OR CONSULT FS-F | 88331 | $434 |
| EMERGENCY DEPT VISIT MOD MDM | 99284 | $440 |
| OFFICE O/P NEW HI 60 MIN | 99205 | $445 |
| HC SKIN TEST TUBERCULOSIS INTRADERMAL | 86580 | $517 |
| EMERGENCY DEPT VISIT HI MDM | 99285 | $635 |
| EGD DIAGNOSTIC BRUSH WASH | 43235 | $645 |
| HC IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR | 96360 | $768 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 88309 | $822 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | 88307 | $823 |
| Head CT Scan | 70450 | $827 |
| CREATE EARDRUM OPENING | 69436 | $925 |
| POLYSOM 6/> YRS 4/> PARAM | 95810 | $947 |
| COLONOSCOPY W/LESION REMOVAL | 45385 | $1,320 |
| HC EXCISION CHALAZION SINGLE | 67800 | $1,413 |
| Cervical Spine MRI | 72141 | $1,434 |
| Lumbar Spine MRI | 72148 | $1,437 |
| Knee MRI | 73721 | $1,619 |
| HC TRABECULOPLASTY LASER SURG 1/> SESSIONS | 65855 | $1,741 |
| Epidural Steroid Injection | 64483 | $2,455 |
| Brain MRI with Contrast | 70553 | $2,504 |
| LAPAROSCOPY APPENDECTOMY | 44970 | $3,240 |
| Laparoscopic Cholecystectomy | 47562 | $3,550 |
| Colonoscopy | 45378 | $3,686 |
| Upper Endoscopy with Biopsy | 43239 | $3,758 |
| PROSTATECTOMY (TURP) | 52601 | $3,830 |
| VAGINAL HYSTERECTOMY | 58260 | $4,480 |
| Colonoscopy with Biopsy | 45380 | $4,815 |
| TLH W/T/O 250 G OR LESS | 58571 | $4,860 |
| MAST SIMPLE COMPLETE | 19303 | $5,145 |
| LAPARO-VAG HYST INCL T/O | 58552 | $5,225 |
| TOTAL HYSTERECTOMY | 58150 | $5,420 |
| Shoulder Arthroscopy | 29827 | $5,740 |
| LAPS SURG PRST8ECT RPBIC RAD | 55866 | $6,250 |
| TREAT THIGH FRACTURE | 27236 | $6,405 |
| MAST MOD RAD | 19307 | $6,805 |
| Total Knee Replacement | 27447 | $6,860 |
| Total Hip Replacement | 27130 | $6,870 |
| REVISE/REPLACE KNEE JOINT | 27486 | $7,515 |
| REVISE/REPLACE KNEE JOINT | 27487 | $9,350 |