FY 18 Top 50 OFFICE PROCEDURES. Procedure Description Units Direct Pay Price

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1 FY 18 Top 50 OFFICE PROCEDURES Description Units Direct Pay Price GASTROENTEROLOGY EST OTPT SERV; LEV 4 (TYPICALLY 25 MIN) EST OTPT SERV; LEV 3 (TYPICALLY 15 MIN) SUBSEQUENT HOSPITAL CARE NEW OTPT SERV; LEV 4 (TYPICALLY 45 MIN) SUBSEQUENT HOSPITAL CARE, COMPREHENSIVE NEW OTPT SERV; LEV 3 (TYPICALLY 30 MIN) INPATIENT CONSULTATION, LEVEL ADMIN OF 1 VACCINE INITIAL HOSPITAL CARE, COMPREHENSIVE EST OTPT SERV; LEV 5 (TYPICALLY 40 MIN) HEP B VACCINE, ADULT, IM UPPR GI ENDOSCOPY, DIAGNOSIS NEW OTPT SERV; LEV 5 (TYPICALLY 60 MIN) OTPT CONSULT-LEV 4 (TYPICALLY 60 MIN) INPATIENT CONSULTATION, LEVEL G8783 BP SCRN PERF REC INTERVAL 62 #N/A INPATIENT CONSULTATION, LEVEL OTPT CONSULT-LEV 3 (TYPICALLY 40 MIN) STUDY RESEARCH/STUDY VISIT 49 #N/A HEP A/HEP B VACC, ADULT IM UPPER GI ENDOSCOPY/LIGATION INITIAL HOSPITAL CARE PROLONGED SERVICE, INPATIENT COLONOSCOPY AND BIOPSY 31 1, INITIAL HOSPITAL CARE, DETAILED OR COMPREHENSIVE Description Units Direct Pay Price INTERNAL MEDICINE SUBSEQUENT HOSPITAL CARE SUBSEQUENT HOSPITAL CARE, COMPREHENSIVE EST OTPT SERV; LEV 4 (TYPICALLY 25 MIN) EST OTPT SERV; LEV 3 (TYPICALLY 15 MIN) INITIAL HOSPITAL CARE HOSPITAL DISCHARGE DAY, MORE THAN 30 MINUTES OBSERVATION CARE HOSPITAL DISCHARGE DAY OBSERVATION CARE DISCHARGE ADMIN OF 1 VACCINE CAPILLARY BLOOD DRAW NEW OTPT SERV; LEV 4 (TYPICALLY 45 MIN) Flu vac no prsv 4 val 3 yrs

2 85610 PROTHROMBIN TIME NEW OTPT SERV; LEV 3 (TYPICALLY 30 MIN) SUBSQUNT OBSRV CARE MOD MDM SUBSEQUENT HOSPITAL CARE, DETAILED OR COMPREHENSIVE OTPT CONSULT-LEV 4 (TYPICALLY 60 MIN) INPATIENT CONSULTATION, LEVEL ELECTROCARDIOGRAM, COMPLETE INITIAL HOSPITAL CARE, COMPREHENSIVE INPATIENT CONSULTATION, LEVEL SUBSQUNT OBSRV CARE HIGH MDM URINALYSIS, AUTO, W/O SCOPE EST OTPT SERV; LEV 2 (TYPICALLY 10 MIN) INITIAL HOSPITAL CARE, DETAILED OR COMPREHENSIVE OBSERV/HOSP SAME DATE G8783 BP SCRN PERF REC INTERVAL 413 #N/A EST OTPT SERV-RN VISIT (TYPICALLY 5 MIN) TDAP VACCINE, 7 YRS & OLDER, IM G0008 ADMIN INFLUENZA VIRUS VAC EST OTPT SERV; LEV 5 (TYPICALLY 40 MIN) INJ FOR TX OR DX; SC OR IM TTE W/DOPPLER, COMPLETE ADMIN OF EACH ADDT'L VACCINE PENUMOCOCCAL VACCINE, 13 VALENT OTPT CONSULT-LEV 3 (TYPICALLY 40 MIN) OBSERVATION CARE, COMPREHENSIVE HEP A/HEP B VACC, ADULT IM ESTAB PREV MED EVAL; AGE YRS INPATIENT CONSULTATION, LEVEL NEW OTPT SERV; LEV 5 (TYPICALLY 60 MIN) G0009 ADMIN PNEUMOCOCCAL VACCINE GLUCOSE BLOOD TEST G8417 Calc BMI ABV Up Param Followup Advncd care plan 30 min OTPT CONSULT-LEV 5 (TYPICALLY 80 MIN) PNEUMOCOCCAL VACCINE OBSERVATION CARE, DETAILED OR COMPREHENSIVE HEP B VACCINE, ADULT, IM Description Units Direct Pay Price PEDIATRICS ESTAB PREV MED EVAL; AGE < 1 YR EST OTPT SERV; LEV 3 (TYPICALLY 15 MIN) ADMIN OF 1 VACCINE W/PHYS COUNSELING PENUMOCOCCAL VACCINE, 13 VALENT EST OTPT SERV; LEV 4 (TYPICALLY 25 MIN) ESTAB PREV MED EVAL; AGE 1-4 YRS HIB VACCINE, PRP-T, IM ROTOVIRUS VACC 3 DOSE, ORAL

3 90471 ADMIN OF 1 VACCINE Flu vac no prsv 4 val 3 yrs DTAP-HEP B-IPV VACCINE, IM CAPILLARY BLOOD DRAW HOSPITAL DISCHARGE DAY DEVELOPMENTAL TEST, LIM HEP A VACC, PED/ADOL, 2 DOSE ADMIN OF EACH ADDT'L VACCINE INIT NB EM PER DAY, HOSP MMR VACCINE, SC CHICKEN POX VACCINE, SC ADMIN OF EACH ADDT'L VACCINE W/PHYS COUNSELING SUBSEQUENT HOSPITAL CARE, DETAILED OR COMPREHENSIVE ESTAB PREV MED EVAL; AGE 5-11 YRS Caregiver health risk assmt BILIRUBIN TOTAL TRANSCUT DTAP VACCINE, < 7 YRS, IM DTAP-HIB-IP VACCINE, IM PURE TONE AUDIOMETRY, AIR INITIAL HOSPITAL CARE, DETAILED OR COMPREHENSIVE ADMIN OF EACH ADDT'L NASAL OR ORAL VACCINE VISUAL ACUITY SCREEN PULSE OXIMETRY POST OP VISIT Brief emotional/behav assmt NEW OTPT SERV; LEV 3 (TYPICALLY 30 MIN) Ocular instrumnt screen bil EST OTPT SERV; LEV 5 (TYPICALLY 40 MIN) NEW PREV MED EVAL; AGE < 1 YR ESTAB NEW PREV MED EVAL; AGE YRS DTAP-IPV VACC 4-6 YR IM Flu vac no prsv 4 val 6-35 m Pt-focused hlth risk assmt SAME DAY NB DISCHARGE SBSQ NB EM PER DAY, HOSP Hpv vaccine non valent im URINALYSIS, AUTO, W/O SCOPE HOSPITAL DISCHARGE DAY, MORE THAN 30 MINUTES INJ FOR TX OR DX; SC OR IM MENINGOCOCCAL VACCINE, IM STREP A ASSAY W/OPTIC HEMOGLOBIN Description Units Direct Pay Price SURGERY POST OP VISIT SUBSEQUENT HOSPITAL CARE, COMPREHENSIVE SUBSEQUENT HOSPITAL CARE, DETAILED OR

4 COMPREHENSIVE EST OTPT SERV; LEV 3 (TYPICALLY 15 MIN) NEW OTPT SERV; LEV 3 (TYPICALLY 30 MIN) CRITICAL CARE SERVICE; MIN SUBSEQUENT HOSPITAL CARE EST OTPT SERV; LEV 4 (TYPICALLY 25 MIN) INITIAL HOSPITAL CARE EST OTPT SERV; LEV 2 (TYPICALLY 10 MIN) INITIAL HOSPITAL CARE, COMPREHENSIVE NEW OTPT SERV; LEV 2 (TYPICALLY 20 MIN) LAPAROSCOPIC CHOLECYSTECTOMY 339 2, OTPT CONSULT-LEV 3 (TYPICALLY 40 MIN) COLONOSCOPY AND BIOPSY 313 1, NEW OTPT SERV; LEV 4 (TYPICALLY 45 MIN) INITIAL HOSPITAL CARE, DETAILED OR COMPREHENSIVE OTPT CONSULT-LEV 2 (TYPICALLY 30 MIN) OBSERVATION CARE, COMPREHENSIVE DIAGNOSTIC COLONOSCOPY 229 1, EMERGENCY DEPT VISIT, LEVEL INPATIENT CONSULTATION, LEVEL LESION REMOVAL COLONOSCOPY / CPT , HOSPITAL DISCHARGE DAY DIAGNOSTIC LARYNGOSCOPY / CPT INPATIENT CONSULTATION, LEVEL LAPAROSCOPY, APPENDECTOMY 166 1, DIAGNOSTIC ANOSCOPY CHEMICAL CAUTERY, TISSUE SUBSQUNT OBSRV CARE LOW MDM ESTABLISH BRAIN CAVITY SHUNT;VENTRICULO , PERITONIAL,PLEURAL,OTHER TERMINUS OBSERVATION CARE NASAL ENDOSCOPY, DX SUBSQUNT OBSRV CARE MOD MDM OBSERVATION CARE, DETAILED OR COMPREHENSIVE LIGATION OF HEMORRHOID(S) NASAL/SINUS ENDOSCOPY, SURG BIOPSY/REMOVAL, LYMPH NODES OPEN DEEP AXILLARY 102 1, NODES REMOVE IMPACTED EAR WAX DX BRONCHOSCOPE/LAVAGE LAPARO HERNIA REPAIR INITIAL 96 1, OTPT CONSULT-LEV 4 (TYPICALLY 60 MIN) COLONOSCOPY, SUBMUCOUS INJ 85 1, RESECT INFERIOR TURBINATE 84 1, INSERTION OF CHEST TUBE UPPER GI ENDOSCOPY, BIOPSY EMERGENCY DEPT VISIT, LEVEL MUSCLE-SKIN GRAFT, TRUNK 74 4, EAR MICROSCOPY EXAMINATION HERNIA REPAIR W/MESH

5 Description Units Direct Pay Price WOMEN S HEALTH EST OTPT SERV; LEV 3 (TYPICALLY 15 MIN) FETAL NON-STRESS TEST URINALYSIS NONAUTOMATED W/O SCOPE EST OTPT SERV; LEV 4 (TYPICALLY 25 MIN) OB US, LIMITED, FETUS(S) POST OP VISIT URINALYSIS, AUTO, W/O SCOPE OB US, FOLLOW-UP, PER FETUS MCPOB OFFICE VISITS - OB GLOBAL EST OTPT SERV; LEV 3 (TYPICALLY 15 MIN) FETAL NON-STRESS TEST URINALYSIS NONAUTOMATED W/O SCOPE EST OTPT SERV; LEV 4 (TYPICALLY 25 MIN) OB US, LIMITED, FETUS(S) POST OP VISIT URINALYSIS, AUTO, W/O SCOPE OB US, FOLLOW-UP, PER FETUS MCPOB OFFICE VISITS - OB GLOBAL URINE PREGNANCY TEST OB US GREATER THAN OR = 14 WKS, SNGL FETUS,AFTER FIRST TRIMESTER EST OTPT SERV; LEV 2 (TYPICALLY 10 MIN) SUBSEQUENT HOSPITAL CARE, COMPREHENSIVE CAPILLARY BLOOD DRAW OB US < 14 WKS, SINGLE FETUS ADMIN OF 1 VACCINE NEW OTPT SERV; LEV 5 (TYPICALLY 60 MIN) EST OTPT SERV; LEV 5 (TYPICALLY 40 MIN) TRANSVAGINAL US, OBSTETRIC GLUCOSE BLOOD TEST NEW OTPT SERV; LEV 3 (TYPICALLY 30 MIN) ESTAB PREV MED EVAL; AGE YRS ESTAB PREV MED EVAL; AGE YRS UMBILICAL ARTERY ECHO FETAL BIOPHYS PROFILE W/NST TDAP VACCINE, 7 YRS & OLDER, IM MIDDLE CEREBRAL ARTERY ECHO OBSTETRICAL CARE 616 5, NEW OTPT SERV; LEV 2 (TYPICALLY 20 MIN) INITIAL HOSPITAL CARE, COMPREHENSIVE LAPAROSCOPY, EXCISE LESIONS 521 2, OB US NUCHAL MEAS, 1 GEST HOSPITAL DISCHARGE DAY NEW PREV MED EVAL; AGE YRS NEW OTPT SERV; LEV 4 (TYPICALLY 45 MIN) INITIAL HOSPITAL CARE TRANSVAGINAL US, NON-OB

6 99386 NEW PREV MED EVAL; AGE YRS INSERT INTRAUTERINE DEVICE SUBSEQUENT HOSPITAL CARE, DETAILED OR COMPREHENSIVE INJ FOR TX OR DX; SC OR IM OBSTETRICAL CARE;VAGINAL DELIVERY ONLY 339 2, OB US, DETAILED, SNGL FETUS Flu vac no prsv 4 val 3 yrs FETAL BIOPHYS PROFIL W/O NST J7298 LEVONORGESTREL IU CONTRACEPT SYSTEM 271 1, ROUTINE VENIPUNCTURE INITIAL HOSPITAL CARE, DETAILED OR COMPREHENSIVE SUBSEQUENT HOSPITAL CARE TLH W/T/O 250 G OR LESS 225 3,067.00