| Administration of vaccine | 90471 | $8 |
| Skin test for tuberculosis | 86580 | $13 |
| Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | 99211 | $15 |
| Blood Glucose Test | 82947 | $23 |
| Manual urinalysis test with examination using microscope, automated | 81001 | $31 |
| Therapeutic Injection | 96372 | $32 |
| Influenza vaccine, quadrivalent, preservative free, 0.5 mL dosage | 90686 | $39 |
| Cholesterol level | 82465 | $41 |
| Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | 99212 | $42 |
| New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more | 99202 | $44 |
| Hemoglobin A1c | 83036 | $54 |
| Complete Blood Count (CBC) | 85025 | $54 |
| Lipid Panel | 80061 | $58 |
| TSH Thyroid Test | 84443 | $62 |
| Pathology examination of tissue using a microscope, limited examination | 88300 | $68 |
| Office Visit (Established Patient) | 99213 | $78 |
| PSA (prostate specific antigen) measurement, total | 84153 | $81 |
| Destruction of precancer skin growth, 1 growth | 17000 | $86 |
| Aspiration and/or injection of fluid from large joint | 20610 | $93 |
| BIOPSY SKIN LESION | 11100 | $94 |
| Office Visit (Complex) | 99214 | $100 |
| Comprehensive Metabolic Panel | 80053 | $104 |
| Office Visit (New Patient) | 99203 | $105 |
| DXA bone density measurement of forearm, finger, hand, or foot | 77081 | $126 |
| Removal of skin tag, 1-15 skin tags | 11200 | $134 |
| Simple or single drainage of skin abscess | 10060 | $138 |
| Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 99215 | $139 |
| Analysis for antibody to HIV-1 and HIV-2 virus | 86703 | $144 |
| Infusion into a vein for hydration, 31-60 minutes | 96360 | $144 |
| Pathology examination of tissue using a microscope | 88302 | $152 |
| Special stained specimen slides to identify organisms including interpretation and report | 88312 | $154 |
| Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less | 11400 | $155 |
| Pathology examination of tissue using a microscope, moderately low complexity | 88304 | $159 |
| Office Visit (New, Complex) | 99204 | $160 |
| Mammogram (Screening) | 77067 | $166 |
| Emergency department visit for problem that may not require health care professional | 99281 | $168 |
| Pathology examination of tissue using a microscope, intermediate complexity | 88305 | $183 |
| New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | 99205 | $191 |
| Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm | 11401 | $202 |
| Needle biopsy of breast | 19100 | $205 |
| Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique | 87491 | $207 |
| X-ray of chest, 1 view | 71045 | $213 |
| Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique | 87591 | $219 |
| Knee X-Ray | 73560 | $236 |
| Emergency department visit with straightforward medical decision making | 99282 | $238 |
| Pathology examination of specimen during surgery, first tissue block | 88331 | $239 |
| Surgical pathology consultation and report on referred material requiring preparation of slides | 88323 | $244 |
| Pathology examination of tissue using a microscope, moderately high complexity | 88307 | $245 |
| Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less | 12001 | $250 |
| Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less | 11440 | $252 |
| X-ray of shoulder, minimum of 2 views | 73030 | $255 |
| Chest X-Ray (2 Views) | 71046 | $273 |
| Repair of anterior cruciate ligament of knee using an endoscope | 29888 | $301 |
| Pathology examination of tissue using a microscope, high complexity | 88309 | $352 |
| Emergency department visit with low level of medical decision making | 99283 | $416 |
| DEXA Bone Density Scan | 77080 | $471 |
| Emergency department visit with moderate level of medical decision making | 99284 | $657 |
| Echocardiogram | 93306 | $848 |
| Emergency department visit with high level of medical decision making | 99285 | $984 |
| Head CT Scan | 70450 | $1,317 |
| Cervical Spine MRI | 72141 | $2,097 |
| Lumbar Spine MRI | 72148 | $2,097 |
| Knee MRI | 73721 | $2,097 |
| Brain MRI with Contrast | 70553 | $2,487 |
| Sleep study in sleep lab (6 years or older) | 95810 | $3,370 |