| New patient visit, level 2 |
$99 |
| New patient visit, level 3 |
$151 |
| New patient visit, level 4 |
$224 |
| New patient visit, level 5 (high severity) |
$282 |
| Well-baby office visit, new patient (under 1 year) |
$129 |
| Well-child office visit, new patient (1 to 4 years) |
$139 |
| Well-child office visit, new patient (5 to 11 years) |
$139 |
| Well-child office visit, new patient (12 to 17 years) |
$150 |
| Well-adult office visit, new patient (18 to 39 years) |
$174 |
| Well-adult office visit, new patient (40 to 64 years) |
$174 |
| Well-adult office visit, new patient (65 and older) |
$174 |
| Group psychological therapy |
$46 |
| Individual psychotherapy, 60 minutes |
$167 |
| Eye exam, routine visit, new patient |
$106 |
| Eye exam and treatment, new patient |
$196 |
| Vision screening test |
$4 |
| Comprehensive audiometry evaluation |
$67 |
| Ear cleaning |
$75 |
| Eardrum test |
$14 |
| Hearing screening test (pure tone, air only) |
$15 |
| Electric stimulation therapy, treatment only |
$20 |
| Physical therapy evaluation |
$89 |
| Physical therapy exercises, treatment only (each 15-minute segment) |
$34 |
| Physical therapy, hot and cold application, treatment only |
$6 |
| Physical therapy, ultrasound, treatment only (each 15-minute segment) |
$15 |
| Manual therapy techniques, each 15 minutes |
$31 |
| Neuromuscular reeducation |
$38 |
| Therapeutic activities |
$39 |
| Immunization administration |
$22 |
| Immunization administration through 18 years of age |
$22 |
| Immunization administration through 18 years of age, additional component |
$6 |
| Allergy shot |
$12 |
| Chicken pox vaccine |
$188 |
| Diphtheria, tetanus booster vaccine |
$30 |
| Diphtheria, tetanus, pertussis vaccine |
$56 |
| Flu shot, children (3 years and older) |
$21 |
| Flu shot, infants |
$21 |
| Flu shot, adults (18 to 64) |
$70 |
| Hepatitis B vaccine |
$72 |
| Measles, mumps, and rubella vaccine |
$99 |
| Polio vaccine |
$44 |
| Breathing capacity test |
$55 |
| Breathing treatment |
$38 |
| Colonoscopy and removal of abnormal tissue using cautery |
$809 |
| Colonoscopy and removal of abnormal tissue using snare technique |
$757 |
| Colonoscopy and removal of colon tissue for examination |
$736 |
| Diagnostic colonoscopy |
$566 |
| Diagnostic proctosigmoidoscopy |
$172 |
| Diagnostic sigmoidoscopy |
$253 |
| Draining fluid from around swollen joint |
$103 |
| Electrocardiogram |
$36 |
| Fetal monitoring |
$81 |
| Incisional biopsy of skin, single lesion |
$181 |
| Punch biopsy of skin, single lesion |
$149 |
| Sigmoidoscopy and removal of tissue for examination |
$322 |
| Stress test |
$129 |
| Surgically destroying an abnormal area of skin |
$147 |
| Tangential biopsy of skin, single lesion |
$119 |
| Ultrasound test of heart |
$380 |
| CT scan of chest, including dye |
$459 |
| CT scan of pelvis, including dye |
$441 |
| CT scan of pelvis, without dye |
$387 |
| CT scan of sinus and nasal passages |
$327 |
| CT scan of stomach area, with dye |
$449 |
| CT scan of stomach area, without dye |
$380 |
| Mammogram (one side) |
$204 |
| Mammogram (two views) |
$258 |
| Mammogram (screening) |
$205 |
| Breast tomosynthesis BI |
$74 |
| MRI brain stem with contrast |
$834 |
| MRI cardiac with, without contrast with stress |
$1264 |
| MRI neck with contrast |
$815 |
| Pregnancy ultrasound |
$179 |
| Review of CT scan of the head or brain |
$308 |
| Ultrasound of pelvis |
$163 |
| Ultrasound of stomach area |
$193 |
| Vaginal ultrasound |
$189 |
| X-ray for osteoporosis |
$185 |
| X-ray of ankle (complete) |
$61 |
| X-ray of both knees |
$68 |
| X-ray of chest (one view) |
$37 |
| X-ray of chest (two views) |
$49 |
| X-ray of finger |
$63 |
| X-ray of foot (complete) |
$54 |
| X-ray of hand (complete) |
$59 |
| X-ray of knee (complete) |
$77 |
| X-ray of stomach area (complete) |
$78 |
| X-ray of wrist (complete) |
$68 |
| Albumin test |
$10 |
| Alkaline phosphatase test |
$9 |
| Allergy test |
$6 |
| In vitro allergen specific IgE testing |
$9 |
| ALT test |
$10 |
| Amylase test |
$12 |
| AST test |
$9 |
| Bilirubin test (total) |
$9 |
| Blood antibody test |
$26 |
| Blood clotting test |
$7 |
| Blood sugar test, diagnostic |
$7 |
| Blood sugar test, monitoring |
$23 |
| Calcium test (total) |
$9 |
| Cholesterol level test |
$8 |
| Complete blood count |
$14 |
| Comprehensive metabolic panel |
$19 |
| Creatinine test |
$9 |
| Hemoglobin A1C |
$18 |
| Hepatitis B surface antigen test |
$19 |
| Hepatitis C test |
$26 |
| Kidney function test |
$16 |
| Laboratory chemistry test for creatine kinase |
$12 |
| Lipid panel test |
$24 |
| Magnesium test |
$12 |
| Pap test, cervical cancer screening |
$39 |
| Phosphorus test |
$9 |
| Routine venipuncture |
$9 |