| Complete Blood Count (CBC) | 85025 | $12 |
| Blood Glucose Test | 82947 | $12 |
| Lipid Panel | 80061 | $12 |
| TSH Thyroid Test | 84443 | $16 |
| HC ADMIN PNEUMOCOCCAL VACCINE CDM | 90471 | $18 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | 87491 | $37 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | 87591 | $37 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $42 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $76 |
| HC CHOLESTEROL | 82465 | $80 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $84 |
| HC PR ADMIN VACCINE INITIAL LTE 18 YEARS OLD VFC CDM | 90460 | $97 |
| Therapeutic Injection | 96372 | $115 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $121 |
| Hemoglobin A1c | 83036 | $153 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $157 |
| HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.5 ML | 90686 | $161 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $172 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $178 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $227 |
| HC PR 99211 ESTAB PT VISIT - LEVEL 1 | 99211 | $239 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB | 88312 | $242 |
| HC HIV-1/HIV-2 SINGLE ASSAY | 86703 | $244 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $271 |
| HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | 10060 | $275 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $304 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $318 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $352 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $352 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $352 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $352 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $363 |
| Comprehensive Metabolic Panel | 80053 | $391 |
| HC PR 11300 SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG | 11300 | $399 |
| HC PR 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O ULTRASOUND GUIDANCE | 20610 | $424 |
| HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM | 12001 | $430 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $434 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $445 |
| Office Visit (Established Patient) | 99213 | $470 – $610 |
| HC PR 11301 SHAVE SKIN LESION 0.6 TO 1.0 CM TRNK ARM LEG | 11301 | $480 |
| Knee X-Ray | 73560 | $506 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $516 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $537 |
| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $539 |
| Mammogram (Screening) | 77067 | $559 |
| DEXA Bone Density Scan | 77080 | $562 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $617 |
| HC XR CHEST 1 VIEW | 71045 | $648 |
| Office Visit (Complex) | 99214 | $663 – $903 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $663 |
| HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | 11400 | $675 |
| Echocardiogram | 93306 | $678 |
| Chest X-Ray (2 Views) | 71046 | $716 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $736 |
| Office Visit (New Patient) | 99203 | $746 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $782 |
| HC PR ED 11401 EXC TR-EXT B9+MARG 0.6-1 CM CDM | 11401 | $844 |
| HC ED SEXUAL ASSAULT EXAM CDM | 99284 | $844 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $888 |
| Office Visit (New, Complex) | 99204 | $1,010 |
| HC PR 99205 NEW PT VISIT - LEVEL 5 | 99205 | $1,082 |
| HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH CDM | 55700 | $1,256 – $1,750 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $1,265 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $1,561 |
| HC PR 19100 BX BREAST PERCUT W/O IMAGE | 19100 | $1,633 |
| Head CT Scan | 70450 | $2,079 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $2,129 |
| Colonoscopy | 45378 | $2,143 |
| Epidural Steroid Injection | 64483 | $2,262 |
| Upper Endoscopy with Biopsy | 43239 | $2,342 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $2,707 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $2,797 |
| Colonoscopy with Biopsy | 45380 | $3,344 |
| Lumbar Spine MRI | 72148 | $3,650 |
| Knee MRI | 73721 | $3,652 |
| Cervical Spine MRI | 72141 | $3,750 |
| HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | 45385 | $4,267 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $5,548 |
| Brain MRI with Contrast | 70553 | $5,939 |
| HC PR 44970 LAPAROSCOPY APPENDECTOMY | 44970 | $6,136 |
| HC PR 52601 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE CDM | 52601 | $6,800 |
| HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | 29881 | $6,914 |
| HC PR 44950 APPENDECTOMY | 44950 | $7,109 |
| HC PR 27236 OPEN TX THIGH FRACTURE W/O MANIP | 27236 | $8,775 |
| Shoulder Arthroscopy | 29827 | $9,460 |
| Laparoscopic Cholecystectomy | 47562 | $11,117 |
| HC PR 29888 KNEE ARTHRO/SURG | 29888 | $11,301 |