| HC ADMIN HEPATITIS B VACCINE CDM | 90471 | $13 |
| HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.5 ML | 90686 | $24 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $28 |
| Blood Glucose Test | 82947 | $33 |
| HC CHOLESTEROL | 82465 | $36 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $36 |
| HC TB INTRADERMAL TEST - PPD | 86580 | $38 |
| HC PR 99211 ESTAB PT VISIT - LEVEL 1 | 99211 | $43 – $156 |
| Complete Blood Count (CBC) | 85025 | $50 |
| HC PR ADMIN VACCINE INITIAL LTE 18 YEARS OLD CDM | 90460 | $53 – $54 |
| HC PR 71045 XR EXAM CHEST 1 VIEW | 71045 | $56 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $64 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $64 |
| EKG (Electrocardiogram) | 93000 | $66 |
| Comprehensive Metabolic Panel | 80053 | $67 |
| HC PR 77081 DXA BONE DENSITY STUDY 1/GT SITES APPENDICLR SKEL | 77081 | $68 |
| HC HIV-1/HIV-2 SINGLE ASSAY | 86703 | $69 |
| Chest X-Ray (2 Views) | 71046 | $73 |
| Knee X-Ray | 73560 | $75 |
| HC PR 73030 XR SHOULER 2 VIEWS | 73030 | $75 |
| Hemoglobin A1c | 83036 | $80 |
| Lipid Panel | 80061 | $82 |
| DEXA Bone Density Scan | 77080 | $83 |
| HC PR 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O ULTRASOUND GUIDANCE | 20610 | $91 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $92 – $205 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | 84153 | $93 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $95 |
| HC CHLAMYDIA TRACHOMATIS PCR | 87491 | $95 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB | 88312 | $101 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $116 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $119 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $119 |
| HC PREV VISIT EST AGE 40-64 | 99396 | $133 |
| HC PREV VISIT NEW AGE 40-64 | 99386 | $133 |
| TSH Thyroid Test | 84443 | $138 |
| HC PR 99395 PREV VISIT EST AGE 18-39 | 99395 | $143 |
| HC PR 17110 DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $148 |
| Office Visit (Established Patient) | 99213 | $151 – $302 |
| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $154 – $310 |
| HC PR 99385 PREV VISIT NEW AGE 18-39 | 99385 | $160 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $161 |
| HC PR 90832 PSYTX W PT 30 MIN RHC | 90832 | $191 |
| Therapeutic Injection | 96372 | $206 |
| HC PR 90791 PSYCH DIAG EVAL RHC | 90791 | $212 |
| Psychotherapy (60 min) | 90837 | $212 |
| HC PR 90834 PSYTX W PT 45 MIN RHC | 90834 | $212 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $222 |
| HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | 12001 | $222 – $531 |
| HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | 43235 | $228 |
| Epidural Steroid Injection | 64483 | $230 |
| Office Visit (New Patient) | 99203 | $235 – $476 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $235 |
| Head CT Scan | 70450 | $235 |
| Office Visit (Complex) | 99214 | $238 – $461 |
| HC PR 11401 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $242 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $244 – $539 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $256 |
| HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML | 90750 | $257 |
| HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE | 10060 | $260 – $577 |
| Mammogram (Screening) | 77067 | $279 |
| Office Visit (New, Complex) | 99204 | $293 – $633 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $300 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $351 |
| HC ED OB FAC E&M VISIT LEVEL 1 CDM | 99281 | $358 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $370 |
| Cervical Spine MRI | 72141 | $425 |
| Lumbar Spine MRI | 72148 | $427 |
| Knee MRI | 73721 | $456 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $458 |
| HC NEW PT VISIT - LEVEL 5 | 99205 | $520 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $520 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $625 |
| Colonoscopy | 45378 | $641 |
| Upper Endoscopy with Biopsy | 43239 | $679 |
| Brain MRI with Contrast | 70553 | $717 |
| Colonoscopy with Biopsy | 45380 | $761 |
| Echocardiogram | 93306 | $776 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $798 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $798 |
| HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | 45385 | $854 |
| HC PR 29881 ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG | 29881 | $857 |
| HC PR 44970 LAPAROSCOPY APPENDECTOMY | 44970 | $910 |
| Laparoscopic Cholecystectomy | 47562 | $993 |
| HC ED FAC E&M VISIT LEVEL 2 CDM | 99282 | $1,005 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $1,282 |
| HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR | 29888 | $1,541 |
| Shoulder Arthroscopy | 29827 | $1,672 |
| HC PR 58571 TLH W/T/O 250 G OR LESS | 58571 | $1,700 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $1,706 |
| HC ED FAC E&M VISIT LEVEL 3 CDM | 99283 | $1,753 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $1,763 |
| HC PR 27236 OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT | 27236 | $1,860 |
| Total Hip Replacement | 27130 | $2,033 |
| Total Knee Replacement | 27447 | $2,101 |
| HC ED FAC E&M VISIT LEVEL 4 CDM | 99284 | $2,726 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $3,496 |
| HC ED FAC E&M VISIT LEVEL 5 CDM | 99285 | $3,535 |