| Blood Glucose Test | 82947 | $22 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $34 |
| HC CHOLESTEROL | 82465 | $46 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $52 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | 87491 | $67 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | 84153 | $68 |
| TSH Thyroid Test | 84443 | $74 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $77 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $77 |
| Hemoglobin A1c | 83036 | $80 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | 87591 | $83 |
| Complete Blood Count (CBC) | 85025 | $85 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $94 |
| Comprehensive Metabolic Panel | 80053 | $94 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $94 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $104 |
| HC PR 99211 ESTAB PT VISIT - LEVEL 1 | 99211 | $105 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $115 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $123 |
| Lipid Panel | 80061 | $132 |
| Therapeutic Injection | 96372 | $145 |
| Office Visit (Established Patient) | 99213 | $146 |
| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $150 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB | 88312 | $153 |
| HC PR 90832 PSYTX W PT 30 MIN RHC | 90832 | $170 |
| Office Visit (Complex) | 99214 | $176 |
| Office Visit (New Patient) | 99203 | $179 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $210 |
| HC XR CHEST 1 VIEW | 71045 | $237 |
| Chest X-Ray (2 Views) | 71046 | $237 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $261 |
| HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $282 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $283 |
| HC ED OB FAC E&M VISIT LEVEL 1 CDM | 99281 | $284 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $291 |
| HC PR 90834 PSYTX W PT 45 MIN RHC | 90834 | $304 |
| Psychotherapy (60 min) | 90837 | $304 |
| Knee X-Ray | 73560 | $310 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $310 |
| Office Visit (New, Complex) | 99204 | $326 |
| HC PR 99205 NEW PT VISIT - LEVEL 5 | 99205 | $342 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $417 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $417 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $417 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $480 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $501 |
| HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | 10060 | $516 |
| HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | 12001 | $516 |
| HC ED OB FAC E&M VISIT LEVEL 2 CDM | 99282 | $540 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $614 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $633 |
| Head CT Scan | 70450 | $807 |
| Cervical Spine MRI | 72141 | $813 |
| HC ED OB FAC E&M VISIT LEVEL 3 CDM | 99283 | $827 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $862 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $864 |
| Lumbar Spine MRI | 72148 | $1,084 |
| Knee MRI | 73721 | $1,084 |
| HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $1,121 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $1,237 |
| HC ED OB FAC E&M VISIT LEVEL 4 CDM | 99284 | $1,394 |
| Echocardiogram | 93306 | $1,496 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $1,499 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $1,499 |
| Brain MRI with Contrast | 70553 | $1,512 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,631 |
| Upper Endoscopy with Biopsy | 43239 | $1,631 |
| Colonoscopy | 45378 | $1,642 |
| HC POLYSOMNOGRAM REDUCED SERVICE | 95810 | $1,754 |
| Epidural Steroid Injection | 64483 | $1,855 |
| HC ED OB FAC E&M VISIT LEVEL 5 CDM | 99285 | $2,810 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $3,207 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $3,314 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $6,572 |