| VFC - 90686 FLUZONE 3+ YEARS - PC - MED CHARGE (INFLUENZA) | 90686 | $0 |
| URINANLYSIS DIPSTICK W/SCOPE POC | 81001 | $5 |
| STOOL FOR OCCULT BLOOD POC-PC | 82270 | $7 |
| Blood Glucose Test | 82947 | $7 |
| ASSAY CHOLESTEROL | 82465 | $7 |
| Knee X-Ray | 73560 | $13 |
| XR CHEST 1 VIEW FRONTAL - REPORT | 71045 | $14 |
| VISIT NON MD EST PT 99211 | 99211 | $15 |
| XR SHOULDER COMPLETE LEFT - REPORT | 73030 | $15 |
| VFC - ADMIN 0-18 W/COUNSEL - PC - ADMIN CHARGE (PNEUMOCOCCAL 20) | 90460 | $16 |
| PPD ADMIN POC | 86580 | $16 |
| VFC - ADMIN 1 VACC - PC - ADMIN CHARGE (PNEUMOCOCCAL 20) | 90471 | $16 |
| Therapeutic Injection | 96372 | $16 |
| DEXA Bone Density Scan | 77080 | $16 |
| XR DEXA VERTEBRAL FRACTURE ASSESSMENT - REPORT | 77081 | $16 |
| Chest X-Ray (2 Views) | 71046 | $17 |
| Comprehensive Metabolic Panel | 80053 | $18 |
| Complete Blood Count (CBC) | 85025 | $18 |
| Hemoglobin A1c | 83036 | $19 |
| EKG (Electrocardiogram) | 93000 | $21 |
| Lipid Panel | 80061 | $27 |
| TSH Thyroid Test | 84443 | $28 |
| REFRACTION 92015 | 92015 | $29 |
| ER VISIT LIMITED | 99281 | $35 |
| PSA TOTAL | 84153 | $39 |
| VISIT STFD 10MN EST PT 99212 | 99212 | $52 |
| INTRAVENOUS INFUSION HYDRATION: INITIAL 31 MIN TO 1 HOUR | 96360 | $56 |
| CORNEAL TOPOGRAPHY 92025 | 92025 | $56 |
| Mammogram (Screening) | 77067 | $59 |
| PATHOLOGY BILLING SURGICAL PATHOLOGY LEVEL II COMPLEXITY | 88302 | $60 |
| PATHOLOGY BILLING SURGICAL PATHOLOGY LEVEL I COMPLEXITY | 88300 | $60 |
| RL-A-CGAMD 60241A | 87491 | $62 |
| RL-A-CGAMD 60241B | 87591 | $62 |
| ER VISIT LOW 99282 | 99282 | $65 |
| Head CT Scan | 70450 | $66 |
| HPV DNA CERVICAL-THINPREP | 87624 | $72 |
| PRC LARGE JOINT ASPIRATION | 20610 | $72 |
| Office Visit (Established Patient) | 99213 | $79 |
| VISIT STFD 15MIN NW PT 99202 | 99202 | $81 |
| Knee MRI | 73721 | $94 |
| DESTRUCTION LESION PREMALIGNANT FIRST LESION 17000 | 17000 | $95 |
| AUTOMATED VISUAL FIELD 92083 | 92083 | $96 |
| Lumbar Spine MRI | 72148 | $102 |
| BIOPSY BREAST NEEDLE CORE W/O US | 19100 | $106 |
| Echocardiogram | 93306 | $106 |
| ER VISIT MOD 99283 | 99283 | $112 |
| Cervical Spine MRI | 72141 | $116 |
| Office Visit (New Patient) | 99203 | $117 |
| VISION TEST NEW PAT | 92002 | $128 |
| REMOVE SKIN TAGS <= 15 LESIONS 11200 | 11200 | $130 |
| VISION TEST ESTAB PATIE | 92012 | $132 |
| REPAIR SUPERFIC WND2.5/< PROFEE | 12001 | $134 |
| Office Visit (Complex) | 99214 | $142 |
| EXC TR/EXT B9 + MARG .6-1 PROFEE | 11401 | $155 |
| SHAVE LESION TRUNK/ARM/LEG < 0.5 CM 11300 | 11300 | $156 |
| I&D ABSCESS SIMPLE PROFEE | 10060 | $157 |
| HIV-1/2 ANTIBODIES RAPID | 86703 | $158 |
| SHAVE LESION SCALP/NECK/HAND/FEET < 0.5 CM 11305 | 11305 | $163 |
| DESTRUCTION LESION BENIGN 1-14 LESIONS 17110 | 17110 | $163 |
| PERIODIC COMP PREVENTIVE MED 18 TO 39 YEARS EST 99395 | 99395 | $170 |
| Epidural Steroid Injection | 64483 | $171 |
| Brain MRI with Contrast | 70553 | $178 |
| SHAVE LESION TRUNK/ARM/LEG 0.6-1.0 CM 11301 | 11301 | $180 |
| PERIODIC COMP PREVENTIVE MED 40 TO 64 YEARS EST 99396 | 99396 | $181 |
| POLYSOMNOGRAPHY INTERPRETATION | 95810 | $183 |
| EXCISION BENIGN TRUNK/ARM/LEG < 0.5 CM 11400 | 11400 | $186 |
| EGD DIAGNOSTIC PC | 43235 | $187 |
| EYE EXAM & TREATMENT 92014 | 92014 | $187 |
| ER VISIT HIGH 99284 | 99284 | $188 |
| INITIAL COMP PREVENTIVE MED 18 TO 39 YEARS NEW 99385 | 99385 | $188 |
| PATHOLOGY BILLING SPECIAL STAINS GROUP I FOR MICROORGANISM | 88312 | $188 |
| DESTRUCTION LESION BENIGN 15 OR MORE 17111 | 17111 | $191 |
| PATHOLOGY BILLING SURGICAL PATHOLOGY LEVEL III COMPLEXITY | 88304 | $191 |
| Office Visit (New, Complex) | 99204 | $207 |
| EXCISION BENIGN FACE/EAR/NOSE/LIP < 0.5 CM 11440 | 11440 | $208 |
| VISIT 40-54MN EST PT 99215 | 99215 | $209 |
| Upper Endoscopy with Biopsy | 43239 | $211 |
| PATHOLOGY BILLING SURGICAL PATHOLOGY LEVEL IV COMPLEXITY | 88305 | $215 |
| INITIAL COMP PREVENTIVE MED 40 TO 64 YEARS NEW 99386 | 99386 | $218 |
| VISIT HIGH 60MN NW PT 99205 | 99205 | $271 |
| ER VISIT HIGH URGENT 99285 | 99285 | $273 |
| PATHOLOGY BILLING FROZEN SINGLE SPECIMEN | 88331 | $274 |
| 90750 SHINGRIX - PC - MED CHARGE (ZOSTER) | 90750 | $276 |
| Colonoscopy | 45378 | $283 |
| Colonoscopy with Biopsy | 45380 | $306 |
| PROSTATE NEEDLE BIOPSY ANY APPROACH 55700 | 55700 | $374 |
| PATHOLOGY BILLING CONSULTATION FEE OUTSIDE SLIDES FROM BLOCK | 88323 | $376 |
| COLONOSCOPY W/SNARE PC | 45385 | $389 |
| ARTHROSCOPY KNEE W/MENISCECTOMY (MEDIAL OR LATERAL) | 29881 | $844 |
| LAPAROSCOPIC APPENDECTOMY PC | 44970 | $859 |
| 88396 AP IRON LIVER TISSUE | 88307 | $907 |
| APPENDECTOMY PC | 44950 | $928 |
| Laparoscopic Cholecystectomy | 47562 | $941 |
| MASTECTOMY PARTIAL | 19301 | $1,022 |
| TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE PC | 52601 | $1,036 |
| APPENDEC RPTD APPENDIX ABSC/PRITONITIS PC | 44960 | $1,265 |
| MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY | 19302 | $1,402 |
| MASTECTOMY SIMPLE COMPLETE | 19303 | $1,481 |
| PATHOLOGY BILLING SURGICAL PATHOLOGY LEVEL VI COMPLEXITY | 88309 | $1,508 |
| ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ PC | 29888 | $1,524 |
| Shoulder Arthroscopy | 29827 | $1,673 |
| MASTECTOMY MODIFIED RADICAL | 19307 | $1,825 |
| LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT 55866 | 55866 | $1,835 |
| HEMIARTHROPLASTY HIP FRACTURE | 27236 | $1,848 |
| Total Knee Replacement | 27447 | $1,984 |
| Total Hip Replacement | 27130 | $2,011 |
| REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT PC | 27486 | $2,186 |
| REVISION OF TOTAL KNEE ARTHROPLASTY W/WO ALLOGRAFT FEMORAL/TIBIAL COMPONENT | 27487 | $2,742 |