| HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL LAB | 82465 | $20 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $23 |
| HC PR 99211 LACTATION CONSULT/LESS THAN 30 MINS | 99211 | $25 |
| Blood Glucose Test | 82947 | $26 |
| Complete Blood Count (CBC) | 85025 | $32 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $35 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $39 |
| Comprehensive Metabolic Panel | 80053 | $43 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $43 |
| Hemoglobin A1c | 83036 | $48 |
| HC PR 88300 BILL SURG LEVEL 1 | 88300 | $48 |
| Lipid Panel | 80061 | $58 |
| HC RAPID HIV 1-2 | 86703 | $66 |
| TSH Thyroid Test | 84443 | $71 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $80 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $87 |
| HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $91 – $1,450 |
| HC CHLAMYDIA AMPLIFICATION APTIMA | 87491 | $94 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM | 87591 | $94 |
| HC PR 88302 BILL SURG LEVEL 2 | 88302 | $96 |
| Therapeutic Injection | 96372 | $96 – $164 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $101 |
| HC TELEH PSYCHOTHERAPY W PT 30 MIN BY HOSP EMPLYED QMP CDM | 90832 | $119 |
| HC PR 88304 BILL SURG LEVEL 3 | 88304 | $123 |
| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $134 |
| HC PR 11305 SHAVE SKIN LESION 0.5 CM OR LESS SCLP NK HND FT GEN | 11305 | $140 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC | 88331 | $153 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $155 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $158 |
| HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | 12001 | $169 |
| HC XR CHEST 1 VIEW | 71045 | $176 |
| Knee X-Ray | 73560 | $178 |
| HC TELEH PSYCHOTHERAPY W PT 45 MIN BY HOSP EMPLYED QMP CDM | 90834 | $180 |
| Office Visit (Established Patient) | 99213 | $189 |
| Chest X-Ray (2 Views) | 71046 | $198 |
| HC PR 88305 BILL SURG LEVEL 4 | 88305 | $206 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $209 – $648 |
| Office Visit (New Patient) | 99203 | $236 |
| Psychotherapy (60 min) | 90837 | $239 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $242 |
| HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM | 11400 | $247 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $247 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $266 |
| Office Visit (Complex) | 99214 | $278 |
| HC PR ED 11200 REMOVAL OF SKIN TAGS CDM | 11200 | $293 |
| HC BILL SURG SPECIAL STAINS GROUP 1 | 88312 | $300 |
| HC BILL SURG CONSULT BLOCKS | 88323 | $303 |
| DEXA Bone Density Scan | 77080 | $308 |
| HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE | 10060 | $311 |
| Mammogram (Screening) | 77067 | $336 |
| Office Visit (New, Complex) | 99204 | $383 |
| HC PR ED 11401 EXC TR-EXT B9+MARG 0.6-1 CM CDM | 11401 | $404 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $412 |
| HC PR 90791 PSYCH DIAG EVAL RHC | 90791 | $425 |
| HC PR ED 99284 VISIT MODERATE MDM CDM | 99284 | $452 |
| HC PR ED 43235 EGD DIAGNOSTIC BRUSH WASH CDM | 43235 | $459 |
| HC DESTRUCTION PREMALIGNANT LESION 1ST | 17000 | $472 |
| Head CT Scan | 70450 | $492 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $497 |
| HC PR 99205 NEW PT VISIT - LEVEL 5 | 99205 | $521 |
| Echocardiogram | 93306 | $558 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $620 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $656 |
| HC BILL SURG LEVEL 5 | 88307 | $685 |
| HC BILL SURG LEVEL 6 | 88309 | $924 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $1,112 |
| Cervical Spine MRI | 72141 | $1,279 |
| Lumbar Spine MRI | 72148 | $1,283 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $1,319 |
| Knee MRI | 73721 | $1,409 |
| Upper Endoscopy with Biopsy | 43239 | $1,548 |
| HC PR ED 27238 CLD TX INTER/PERI/OR SUB-TROCHANTERIC THIGH FX W/O MANIP CDM | 27238 | $1,824 |
| Brain MRI with Contrast | 70553 | $1,898 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $1,934 |
| Colonoscopy | 45378 | $2,104 |
| Epidural Steroid Injection | 64483 | $2,833 |
| HC POLYSOMNOGRAM REDUCED SERVICE | 95810 | $2,839 |
| HC BIOPSY OF PROSTATE | 55700 | $3,816 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $4,136 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $8,478 |