| Thyroid Stimulating Hormone (TSH) | 84443 | $43 |
| Fecal Occult Blood Test | 82270 | $57 |
| Blood Glucose Test | 82947 | $72 |
| Cholesterol Test | 82465 | $73 |
| Screening Mammogram | 77067 | $85 |
| Urinalysis | 81001 | $96 |
| Therapeutic Injection | 96372 | $97 – $124 |
| Joint Injection (large) | 20610 | $103 – $522 |
| Vaccine Administration | 90471 | $106 – $124 |
| Established Patient Visit (Level 1) | 99211 | $106 |
| Complete Blood Count (CBC) | 85025 | $119 |
| Surgical Pathology (level 1) | 88300 | $120 |
| Hemoglobin A1c | 83036 | $152 |
| Gonorrhea Test | 87591 | $164 |
| Chlamydia/Gonorrhea Test | 87491 | $166 |
| Cholesterol Panel (Lipids) | 80061 | $169 |
| HIV Test | 86703 | $177 |
| Surgical Pathology (level 2) | 88302 | $182 |
| New Patient Visit (Level 2) | 99202 | $212 |
| Established Patient Visit (Level 2) | 99212 | $217 |
| Simple Laceration Repair | 12001 | $218 – $359 |
| Special Stain | 88312 | $226 |
| Comprehensive Metabolic Panel | 80053 | $253 |
| IV Infusion (first hour) | 96360 | $261 – $407 |
| PSA (Prostate Screening) | 84153 | $267 |
| Abscess Incision & Drainage | 10060 | $285 – $359 |
| Skin Tag Removal | 11200 | $291 – $359 |
| Shave Removal (1.1-2.0cm) | 11305 | $303 – $359 |
| PT Evaluation – Low Complexity | 97161 | $306 |
| Chest X-Ray (1 view) | 71045 | $309 |
| PT Evaluation – Moderate Complexity | 97162 | $315 |
| PT Evaluation – High Complexity | 97163 | $321 |
| Shave Removal (0.5cm or less) | 11300 | $330 – $692 |
| Established Patient Visit (Level 3) | 99213 | $335 |
| Surgical Pathology (level 3) | 88304 | $336 |
| Excision Benign Lesion (0.5cm or less) | 11400 | $343 – $1,244 |
| X-Ray Knee (2 views) | 73560 | $361 |
| Bone Density Scan – Appendicular | 77081 | $367 |
| Chest X-Ray (2 views) | 71046 | $380 |
| Pathology Consultation | 88323 | $395 |
| Surgical Pathology (level 4) | 88305 | $400 |
| Shave Removal (0.6-1.0cm) | 11301 | $413 |
| Excision Benign Face Lesion (0.5cm) | 11440 | $452 – $1,244 |
| X-Ray Shoulder | 73030 | $506 |
| Excision Benign Lesion (0.6-1.0cm) | 11401 | $535 – $692 |
| Established Patient Visit (Level 4) | 99214 | $576 |
| New Patient Visit (Level 3) | 99203 | $603 |
| Bone Density Scan (DEXA) | 77080 | $628 |
| Breast Biopsy | 19100 | $737 – $2,814 |
| Shingles Vaccine | 90750 | $827 |
| Established Patient Visit (Level 5) | 99215 | $843 |
| New Patient Visit (Level 4) | 99204 | $863 |
| Turbinate Ablation | 30801 | $880 – $2,706 |
| Ear Tubes (Tympanostomy) | 69436 | $969 – $2,706 |
| Surgical Pathology (level 5) | 88307 | $986 |
| New Patient Visit (Level 5) | 99205 | $1,103 |
| Surgical Pathology (level 6) | 88309 | $1,139 – $1,312 |
| Echocardiogram | 93306 | $1,153 |
| Upper GI Endoscopy | 43235 | $1,481 – $1,619 |
| Sinus Surgery (FESS) | 31237 | $1,494 – $2,993 |
| Tonsillectomy (Child) | 42825 | $1,542 – $10,172 |
| Tonsillectomy & Adenoidectomy (Child) | 42820 | $1,562 – $10,172 |
| Tonsillectomy (Adult) | 42826 | $1,565 – $5,473 |
| Endoscopy with Biopsy | 43239 | $1,646 |
| Tonsillectomy & Adenoidectomy (Adult) | 42821 | $1,656 – $5,473 |
| Colonoscopy (screening) | 45378 | $1,760 |
| Turbinate Reduction | 30130 | $1,883 – $5,473 |
| Vasectomy | 55250 | $1,918 – $3,586 |
| Colonoscopy with Biopsy | 45380 | $2,112 |
| CT Head/Brain | 70450 | $2,252 |
| Submucous Turbinate Resection | 30140 | $2,370 – $5,473 |
| Colonoscopy with Polyp Removal | 45385 | $2,402 |
| Laparoscopic Hernia Repair | 49650 | $2,863 – $10,121 |
| Epidural Steroid Injection | 64483 | $2,898 |
| Sleep Study (Polysomnography) | 95810 | $3,193 |
| Cervical Spine MRI | 72141 | $3,386 |
| Lumbar Spine MRI | 72148 | $3,537 |
| Laparoscopic Appendectomy | 44970 | $3,594 – $10,121 |
| MRI Knee | 73721 | $3,759 |
| Septoplasty (Deviated Septum Repair) | 30520 | $3,979 – $5,473 |
| Brain MRI with/without contrast | 70553 | $4,277 |
| Laparoscopic Cholecystectomy | 47562 | $4,462 – $10,121 |