| PR BLOOD OCCULT, BY PEROX, FECES, SINGLE, COLORECT SCRN | 82270 | $14 |
| Complete Blood Count (CBC) | 85025 | $17 |
| Blood Glucose Test | 82947 | $17 |
| PR URINALYSIS, AUTO, W/SCOPE | 81001 | $18 |
| PR TB INTRADERMAL TEST | 86580 | $19 |
| Hemoglobin A1c | 83036 | $21 |
| PR CHYLMD TRACH, DNA, AMP PROBE | 87491 | $23 |
| PR N.GONORRHOEAE, DNA, AMP PROB | 87591 | $23 |
| PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID | 90460 | $24 |
| Comprehensive Metabolic Panel | 80053 | $25 |
| Lipid Panel | 80061 | $27 |
| PR XRAY, CHEST, 1 VIEW | 71045 | $36 |
| HC CHOLESTEROL | 82465 | $36 |
| Chest X-Ray (2 Views) | 71046 | $37 |
| Knee X-Ray | 73560 | $38 |
| Therapeutic Injection | 96372 | $38 |
| TSH Thyroid Test | 84443 | $39 |
| PR X-RAY SHOULDER 2+ VW | 73030 | $41 |
| PR EMERGENCY DEPT VISIT,LEVEL I | 99281 | $42 |
| CHG HIV-1/HIV-2, SINGLE ASSAY | 86703 | $48 |
| HC TISSUE, GROSS ONLY, LEVEL I | 88300 | $48 |
| HC TISSUE, G & M, LEVEL III | 88304 | $56 |
| Mammogram (Screening) | 77067 | $68 |
| EKG (Electrocardiogram) | 93000 | $71 |
| PR PROSTATE SPECIFIC ANTIGEN,TOTAL | 84153 | $76 |
| HC TISSUE, G & M, LEVEL II | 88302 | $77 |
| PR EMERGENCY DEPT VISIT,LEVEL II | 99282 | $78 |
| *HC SPECIAL STAIN GRP 1 | 88312 | $81 |
| HC PSYCHOTHERAPY W/ PATIENT 30 MINUTES | 90832 | $86 |
| PR EYE EXAM, EST PATIENT,INTERMED | 92012 | $89 |
| PR VISUAL FIELD EXAM,EXTENDED | 92083 | $93 |
| HC TISSUE, G & M, LEVEL IV | 88305 | $99 |
| PR SHAV SKIN LES <0.5 CM REMAINDER BODY | 11305 | $100 |
| PR EYE EXAM, NEW PATIENT,INTERMED | 92002 | $100 |
| PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID | 90471 | $101 |
| HC OR CONSULT W/FROZ SECT/SMR 1ST | 88331 | $112 |
| PR DESTRUCTION(LASER SURGERY,CRYOSURGERY,CHEMOSURGERY),PREMALIGNANT LESIONS,FIRST LESION | 17000 | $113 |
| PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG | 11300 | $115 |
| PR EMERGENCY DEPT VISIT,LEVEL III | 99283 | $117 |
| *HC HPV DNA HIGH RISK | 87624 | $118 |
| PR SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG | 11301 | $118 |
| PR REMOVAL OF SKIN TAGS, UP TO 15 | 11200 | $122 |
| PR EYE EXAM, EST PATIENT,COMPREHESV | 92014 | $122 |
| HC OFFICE/OUTPT VISIT, EST, LEVL I | 99211 | $130 |
| HC PSYCHOTHERAPY W/PATIENT 45 MINUTES | 90834 | $131 |
| PR OFFICE/OUTPT VISIT, EST, LEVL II, 10-19 MIN | 99212 | $134 |
| Office Visit (Established Patient) | 99213 | $137 |
| PR PREVENTIVE VISIT,EST,40-64 | 99396 | $141 |
| PR PREVENTIVE VISIT,EST,18-39 | 99395 | $141 |
| Office Visit (Complex) | 99214 | $141 |
| PR OFFICE/OUTPT VISIT, NEW, LEVL II, 15-29 MIN | 99202 | $141 |
| Head CT Scan | 70450 | $144 |
| PR PREVENTIVE VISIT,NEW,18-39 | 99385 | $145 |
| Office Visit (New Patient) | 99203 | $145 |
| HC TISSUE, G & M, LEVEL V | 88307 | $147 |
| PR PREVENTIVE VISIT,NEW,40-64 | 99386 | $149 |
| Office Visit (New, Complex) | 99204 | $149 |
| Echocardiogram | 93306 | $156 |
| Psychotherapy (60 min) | 90837 | $157 |
| PR DRAIN SKIN ABSCESS SIMPLE | 10060 | $159 |
| PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG | 11400 | $160 |
| PR EYE EXAM, NEW PATIENT,COMPREHESV | 92004 | $169 |
| PR EMERGENCY DEPT VISIT,LEVEL IV | 99284 | $176 |
| PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG | 11401 | $186 |
| PR PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $190 |
| PR EXC SKIN BENIG <0.5 CM FACE,FACIAL | 11440 | $201 |
| PR BIOPSY OF BREAST, NEEDLE CORE | 19100 | $201 |
| HC IV INFUSION - HYDRATION, INITIAL, 31 MIN - 1 HOUR | 96360 | $204 |
| HC TISSUE, G & M, LEVEL VI | 88309 | $204 |
| PR DESTRUCTION BENIGN LESIONS UP TO 14 | 17110 | $209 |
| Knee MRI | 73721 | $213 |
| PR CAUTER TURBINATE MUCOSA,SUPERFICIAL | 30801 | $215 |
| PR DESTRUCTION BENIGN LESIONS 15 OR MORE | 17111 | $226 |
| PR RESUPERF WND BODY <2.5CM | 12001 | $232 |
| PR POLYSOMNOGRAPHY, 1-3 | 95808 | $236 |
| PR EXCIS CHALAZION,SINGLE | 67800 | $236 |
| PR EMERGENCY DEPT VISIT,LEVEL V | 99285 | $258 |
| Cervical Spine MRI | 72141 | $269 |
| PR INCISION EARDRUM,ASPIR | 69420 | $277 |
| HC OFFICE/OUTPT VISIT, EST, LEVL V, 40-54 MIN | 99215 | $328 |
| HC OFFICE/OUTPT VISIT, NEW, LEVL V, 60-74 MIN | 99205 | $345 |
| PR BIOPSY OF PROSTATE,NEEDLE/PUNCH | 55700 | $366 |
| PR POLYSOMNOGRAPHY, 4 OR MORE | 95810 | $388 |
| HC ARTHROCENTESIS MAJOR JOINT | 20610 | $435 |
| HC CONSULT OUT. SLIDES W/MATERIAL | 88323 | $506 |
| Epidural Steroid Injection | 64483 | $555 |
| PR EXCIS CHALAZION,MULT,BOTH LIDS | 67805 | $616 |
| PR TRABECULOPLASTY LASER SURGERY | 65855 | $694 |
| PR CLOSED RX INTER/SUBTROCH FEMUR FX | 27238 | $727 |
| PR NASAL/SINUS ENDOSCOPY,BX/RMV POLYP/DEBRID | 31237 | $1,248 |
| Colonoscopy | 45378 | $1,417 |
| Colonoscopy with Biopsy | 45380 | $1,473 |
| PR TRANSURETHRAL ELEC-SURG PROSTATECTOM | 52601 | $1,534 |
| PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY | 58571 | $1,596 |
| Lumbar Spine MRI | 72148 | $1,597 |
| HC EGD DX (INCL BRUSH/WASH) | 43235 | $1,664 |
| Upper Endoscopy with Biopsy | 43239 | $1,732 |
| HC COLON W/REMOVAL BY SNARE TECH | 45385 | $1,987 |
| Laparoscopic Cholecystectomy | 47562 | $2,003 |
| PR TOTAL ABDOM HYSTERECTOMY | 58150 | $2,217 |
| Brain MRI with Contrast | 70553 | $2,481 |