| HC URINALYSIS, AUTO W/MICRO | 81001 | $6 |
| HC NMR CHOLESTEROL ASSAY | 82465 | $7 |
| HC OCCULT BLOOD SCREEN | 82270 | $8 |
| Blood Glucose Test | 82947 | $8 |
| TUBERCULIN PPD 5 TUB. UNIT /0.1 ML IDRM SOLN | 86580 | $13 |
| PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID | 90471 | $14 |
| Lipid Panel | 80061 | $14 |
| Complete Blood Count (CBC) | 85025 | $14 |
| TSH Thyroid Test | 84443 | $16 |
| Hemoglobin A1c | 83036 | $16 |
| PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID | 90460 | $16 |
| Therapeutic Injection | 96372 | $17 |
| HC PSA, TOTAL-REF LAB ONLY | 84153 | $17 |
| Comprehensive Metabolic Panel | 80053 | $19 |
| Mammogram (Screening) | 77067 | $19 |
| HC HIV 1/2 AB, DONOR EVAL (BLOOD CENTER) | 86703 | $20 |
| HC TISSUE, GROSS ONLY, LEVEL I | 88300 | $24 |
| HC TISSUE, G & M, LEVEL II | 88302 | $26 |
| TISSUE EXAM BY PATHOLOGIST | 88305 | $29 |
| HC GC BY AMPLIFIED PROBE | 87591 | $30 |
| HC CHLAMYDIA T BY AMPLIFIED PROBE | 87491 | $37 |
| HC HPV,HIGH RISK TYPES, POOLED RESULT | 87624 | $38 |
| HC OFFICE/OUTPT VISIT, EST, LEVL I | 99211 | $40 |
| HC OFFICE/OUTPT VISIT, EST, LEVL II, 10-19 MIN | 99212 | $43 |
| HC OFFICE/OUTPT VISIT, NEW, LEVL II, 15-29 MIN | 99202 | $44 |
| Office Visit (Established Patient) | 99213 | $45 |
| Office Visit (New Patient) | 99203 | $47 |
| Office Visit (Complex) | 99214 | $47 |
| HC TISSUE, G & M, LEVEL III | 88304 | $49 |
| Office Visit (New, Complex) | 99204 | $49 |
| HC OFFICE/OUTPT VISIT, EST, LEVL V, 40-54 MIN | 99215 | $50 |
| HC EMER ROOM LEVEL I | 99281 | $51 |
| HC OFFICE/OUTPT VISIT, NEW, LEVL V, 60-74 MIN | 99205 | $52 |
| HC DEXA BONE DENSITY APPEN SKEL | 77081 | $54 |
| Chest X-Ray (2 Views) | 71046 | $64 |
| HC EMER ROOM LEVEL II | 99282 | $76 |
| Knee X-Ray | 73560 | $76 |
| HC SPECIAL STAIN GRP 1, EA (-RL) | 88312 | $77 |
| HC SHOULDER ROUTINE | 73030 | $81 |
| HC XRAY, CHEST, 1 VIEW | 71045 | $83 |
| HC EMER ROOM LEVEL III | 99283 | $114 |
| HC SIM REP S/N/A/G/TR/E <2.5CM | 12001 | $124 |
| HC INCISION & DRAINAGE SINGLE | 10060 | $124 |
| HC EXC SKIN TAGS UP TO AND INC 15 LESIONS | 11200 | $128 |
| PR DESTRUCTION(LASER SURGERY,CRYOSURGERY,CHEMOSURGERY),PREMALIGNANT LESIONS,FIRST LESION | 17000 | $128 |
| PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG | 11300 | $128 |
| HC DESTRUCT BENIGN LESION 1-14 | 17110 | $134 |
| PR DESTRUCTION BENIGN LESIONS 15 OR MORE | 17111 | $134 |
| DEXA Bone Density Scan | 77080 | $142 |
| HC IV INFUSION - HYDRATION, INITIAL, 31 MIN - 1 HOUR | 96360 | $143 |
| HC TISSUE, G & M, LEVEL V | 88307 | $164 |
| HC OR CONSULT W/FROZ SECT/SMR 1ST | 88331 | $164 |
| HC EMER ROOM LEVEL IV | 99284 | $168 |
| HC ARTHROCENTESIS MAJOR JOINT | 20610 | $187 |
| HC EMER ROOM LEVEL V | 99285 | $226 |
| PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG | 11401 | $236 |
| HC TISSUE, G & M, LEVEL VI | 88309 | $262 |
| Echocardiogram | 93306 | $405 |
| HC EXC LESION TRUNK,ARMS,LEGS BGN <.5CM | 11400 | $440 |
| Epidural Steroid Injection | 64483 | $511 |
| Colonoscopy | 45378 | $540 |
| HC EGD DX (INCL BRUSH/WASH) | 43235 | $565 |
| Upper Endoscopy with Biopsy | 43239 | $565 |
| Head CT Scan | 70450 | $625 |
| HC COLON W/REMOVAL BY SNARE TECH | 45385 | $712 |
| Colonoscopy with Biopsy | 45380 | $712 |
| Knee MRI | 73721 | $728 |
| HC POLYSOMNOGRAPHY, 4 OR MORE | 95810 | $760 |
| Lumbar Spine MRI | 72148 | $793 |
| Cervical Spine MRI | 72141 | $793 |
| PR BIOPSY OF BREAST, NEEDLE CORE | 19100 | $1,024 |
| Brain MRI with Contrast | 70553 | $1,199 |
| HC PROSTATE NEEDLE BIOPSY | 55700 | $1,322 |
| CREATE EARDRUM OPENING | 69436 | $1,773 |
| REMOVAL OF TONSILS | 42826 | $2,222 |
| REMOVE TONSILS AND ADENOIDS | 42821 | $2,704 |
| REMOVE TONSILS AND ADENOIDS | 42820 | $2,761 |
| RESECT INFERIOR TURBINATE | 30140 | $2,794 |
| REMOVAL OF TONSILS | 42825 | $2,987 |
| EXCISE INFERIOR TURBINATE | 30130 | $3,393 |
| Laparoscopic Cholecystectomy | 47562 | $3,411 |
| KNEE ARTHROSCOPY/SURGERY | 29881 | $3,534 |
| NASAL/SINUS ENDOSCOPY SURG | 31237 | $4,378 |
| PARTICAL MASTECTOMY | 19301 | $5,021 |
| LAPAROSCOPY APPENDECTOMY | 44970 | $5,202 |
| KNEE ARTHROSCOPY/SURGERY | 29888 | $6,504 |
| REPAIR OF NASAL SEPTUM | 30520 | $6,574 |
| Shoulder Arthroscopy | 29827 | $7,027 |
| Total Knee Replacement | 27447 | $9,899 |
| Total Hip Replacement | 27130 | $11,423 |