| TSH Thyroid Test | 84443 | $32 – $125 |
| HC PREVENT MED COMPRE EST,40-64 AGE B | 99396 | $42 |
| HC SKIN TEST - TUBERCULOSIS, INTRADERMAL | 86580 | $43 – $50 |
| HC 92015 DETERMINATION OF REFR1 STATE | 92015 | $43 |
| HC 99211 OP VISIT, EST PT, LEVEL IA | 99211 | $47 |
| Therapeutic Injection | 96372 | $47 |
| HC IMMUNIZATION ADMINISTRAT, ONE VACCINE | 90471 | $47 |
| HC PREVENT MED COMPRE EST, 18-39 AGE A | 99395 | $50 |
| Blood Glucose Test | 82947 | $52 – $71 |
| HC CA SCREEN, OCCULT BLOOD, 1-3 DETERM | 82270 | $52 – $59 |
| HC CHOLESTEROL, SERUM, TOTAL | 82465 | $52 – $77 |
| HC URINALYSIS, AUTO W/SCOPE | 81001 | $55 – $97 |
| HC SO GONORRHOEAE AMP PROBE, CGRNA | 87591 | $56 |
| HC SO CHLAMYDIA AMP PROBE, CGRNA | 87491 | $56 |
| HC 99212 OP VISIT, EST PT, LEVEL IIA | 99212 | $80 |
| Complete Blood Count (CBC) | 85025 | $80 – $96 |
| Hemoglobin A1c | 83036 | $82 |
| Office Visit (Established Patient) | 99213 | $85 |
| HC SURG PATH LEVEL I, GROSS ONLY | 88300 | $86 – $118 |
| HC PREVENT MED COMPRE NEW, 40-64 AGE B | 99386 | $101 |
| HC PREVENT MED COMPRE NEW, 18-39 AGE B | 99385 | $101 |
| HC SHVING LES OTHER <=.5CM | 11305 | $114 |
| HC 96360 IV INF,HYDR;INIT 31 MIN TO 1 HOUR | 96360 | $129 |
| HC 20610 PRO INJ/ARTHRO,MAJOR JT/BURSA/GAN; WO GUIDE - LT | 20610 | $130 |
| HC 17000 PRO DESTRUCTION PREMALIGNANT LESIONS; FIRST LESION | 17000 | $131 |
| HC 99202 OP VISIT, NEW PT, LEVEL IIA | 99202 | $131 |
| HC 17110 PRO DESTRUCTION OF BENIGN LESIONS; UP TO 14 LESIONS | 17110 | $135 |
| Lipid Panel | 80061 | $140 – $206 |
| HC INF AGENT,DNA OR RNA; HPV HIGH-RISK TYPES | 87624 | $145 – $173 |
| HC 11200 RMVL OF SKIN TAG UP TO 15 LESIONS | 11200 | $145 |
| HC EXC BEN LES TRK/ARM/LEG <=.5CM | 11400 | $149 |
| HC EXC BEN LES HEAD <=.5CM | 11440 | $149 |
| HC SHAVING TRK/ARM/LG, <= 0.5 | 11300 | $149 |
| HC SHVNG,TRK/ARM/LEG, 0.6 TO 1.0 | 11301 | $151 |
| HC LAB PSA TOTAL | 84153 | $152 – $380 |
| HC SCAN COMP OPTH DX IMAGING, POST RETINA W/ I & R | 92134 | $152 |
| HC DEST FLAT WART/MOLLUS/MILIA 14+ | 17111 | $157 |
| HC 90832 PSYCHOTHERAPY 30 MIN W/PT | 90832 | $161 |
| HC SFMC FUNG SILVER STAIN LAB TEST | 88312 | $161 |
| HC EXC BEN LES TRK/ARM/LEG .6 TO 1CM | 11401 | $163 |
| Office Visit (Complex) | 99214 | $164 |
| HC 12001 SIM REP,SLP,NCK,AXL,TRK,EXT<=2.5 | 12001 | $169 |
| HC 92083 VISUAL FIELD EXAM, EXTENDED | 92083 | $187 |
| Office Visit (New Patient) | 99203 | $190 |
| HC 10060 INC/DRN ABCSS/CYST SMPL SINGLE | 10060 | $191 |
| Comprehensive Metabolic Panel | 80053 | $193 – $341 |
| HC 99281 ED VISIT LEVEL I | 99281 | $211 |
| HC 90834 PSYCHOTHERAPY 45 MIN W/PT | 90834 | $215 |
| HC 99215 OP VISIT, EST PT, LEVEL VA | 99215 | $241 |
| Office Visit (New, Complex) | 99204 | $266 |
| Psychotherapy (60 min) | 90837 | $270 |
| HC 77081 BC-DEXA,1 OR MORE SITES,APNDIC SKELETON | 77081 | $272 |
| HC 71045 CHEST SINGLE VIEW | 71045 | $279 |
| HC 90791 PRO PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $284 |
| HC LEVEL II SURG PATH GROSS & MICRO | 88302 | $301 – $337 |
| Mammogram (Screening) | 77067 | $325 |
| Chest X-Ray (2 Views) | 71046 | $329 |
| HC 99205 OP VISIT, NEW PT, LEVEL VA | 99205 | $339 |
| HC LEVEL III SURG PATH GROSS & MICRO ONLY | 88304 | $383 – $430 |
| HC FROZEN SECTION | 88331 | $386 – $434 |
| DEXA Bone Density Scan | 77080 | $423 |
| HC 99282 ED VISIT, LEVEL II | 99282 | $437 |
| HC LEVEL IV SURG PATH GROSS & MICRO | 88305 | $468 – $527 |
| Colonoscopy | 45378 | $501 |
| HC EGD, TRANSORAL DIAG W/SPEC COLL | 43235 | $511 |
| HC 73030 SHOULDER COMPLETE, MIN 2V-LT | 73030 | $521 |
| Knee X-Ray | 73560 | $521 |
| HC LEVEL V SURG PATH GROSS & MICRO ONLY | 88307 | $538 – $603 |
| HC 99283 ED VISIT, LEVEL III | 99283 | $745 |
| HC 27238 CLSD TROCHAN FEMORAL FX,W/O MANIP RT | 27238 | $962 |
| Upper Endoscopy with Biopsy | 43239 | $1,039 |
| HC LEVEL VI SURG PATH GROSS & MICRO ONLY | 88309 | $1,084 – $1,319 |
| HC 95810 POLYSOMNOGRAPHY, 4 OR > PARAM | 95810 | $1,135 |
| HC 99284 ED VISIT, LEVEL IV | 99284 | $1,181 |
| HC 99285 ED VISIT, LEVEL V | 99285 | $1,963 |
| Epidural Steroid Injection | 64483 | $2,009 |
| Head CT Scan | 70450 | $2,253 |
| Echocardiogram | 93306 | $3,079 |
| Cervical Spine MRI | 72141 | $3,380 |
| Knee MRI | 73721 | $3,380 |
| Lumbar Spine MRI | 72148 | $3,380 |
| Brain MRI with Contrast | 70553 | $3,613 |
| HC 95808 POLYSOMNOGRAPH, 1-3 ADD PARAM-REDUCE | 95808 | $3,801 |
| HC 31237 NASAL/SINUS ENDOSCOPY SURG W BIOPSY POLYPECT/DEBRIDE, SEP PROC | 31237 | $3,919 |