| HC DETERMINATION REFRACTIVE STATE | 92015 | $17 |
| Blood Glucose Test | 82947 | $23 |
| HC OCCULT BLOOD FECAL SCR 1-3 DETERM | 82270 | $43 |
| HC CHOLESTEROL TOTAL REF1 | 82465 | $49 |
| HC ADMIN VACCINE SINGLE | 90471 | $62 |
| HC URINALYSIS AUTO W/MICROSCOPIC POC | 81001 | $68 |
| HC TB INTRADERMAL TEST | 86580 | $68 |
| Complete Blood Count (CBC) | 85025 | $99 |
| HC PREVENT 18-39 YRS PERIODIC | 99395 | $105 |
| HC PREVENT 40-64YRS PERIODIC | 99396 | $105 |
| HC LEVEL 1 SURG PATH GROSS EXAM | 88300 | $113 |
| HC PREVENT 18-39 YRS INITIAL | 99385 | $136 |
| HC PREVENT 40-64 YRS INITIAL | 99386 | $136 |
| Lipid Panel | 80061 | $160 |
| HC CONSULT/REPORT REFERRED W/SLIDE PREP | 88323 | $168 |
| Hemoglobin A1c | 83036 | $170 |
| HC EST PT LEVEL 1 | 99211 | $184 |
| TSH Thyroid Test | 84443 | $185 |
| HC NEW PT LEVEL 2 | 99202 | $200 |
| HC EST PT LEVEL 2 | 99212 | $200 |
| HC PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL | 84153 | $205 |
| Zoster Vac Recomb Adjuvanted 50 MCG/0.5ML Susr 1 Each Vial | 90750 | $211 |
| HC LEVEL 2 SURG PATH GROSS & MICROSCOPIC | 88302 | $213 |
| HC CORNEAL TOPOGRAPHY | 92025 | $216 |
| Office Visit (New Patient) | 99203 | $221 |
| Office Visit (Established Patient) | 99213 | $221 |
| HC COMP OPHTH IMG POS RETINA I&R UNI/BI | 92134 | $233 |
| HC HIV1 & HIV2 SINGLE RESULT REF1 | 86703 | $239 |
| Office Visit (New, Complex) | 99204 | $246 |
| Office Visit (Complex) | 99214 | $246 |
| HC GROUP 1 SPECIAL STAINS MICROORGANISMS | 88312 | $251 |
| HC OPTH SVC E&M INT EST PT | 92012 | $255 |
| HC LEVEL 3 SURG PATH GROSS & MICROSCOPIC | 88304 | $258 |
| HC PSYTX PT 30 MIN | 90832 | $268 |
| HC EST PT LEVEL 5 | 99215 | $268 |
| HC NEW PT LEVEL 5 | 99205 | $268 |
| HC N GONORRHOEAE AMP PROBE ALT TG REF1 | 87591 | $280 |
| HC OPTH SVC E&M COMP EST PT | 92014 | $281 |
| Therapeutic Injection | 96372 | $290 |
| Comprehensive Metabolic Panel | 80053 | $304 |
| HC C TRACHOMATIS AMP PROBE ALT TG REF1 | 87491 | $309 |
| HC PSYTX PT 45 MIN | 90834 | $311 |
| HC HPV HI RISK AMP PRB POOLD RESLT REF1 | 87624 | $313 |
| HC XR CHEST 1 VIEW | 71045 | $321 |
| Psychotherapy (60 min) | 90837 | $328 |
| HC DXA BONE DENSITY/PERIPHERAL | 77081 | $334 |
| HC PATH CON INTRAOP FROZN TISSUE SECTION | 88331 | $352 |
| HC LEVEL 4 SURG PATH GROSS & MICROSCOPIC | 88305 | $411 |
| HC VISUAL FIELD EXAM EXTENDED | 92083 | $454 |
| DEXA Bone Density Scan | 77080 | $464 |
| Chest X-Ray (2 Views) | 71046 | $464 |
| Knee X-Ray | 73560 | $484 |
| Mammogram (Screening) | 77067 | $499 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $548 |
| HC PSYCH DIAGNOSTIC EVALUATION | 90791 | $618 |
| HC SHAVE LESN SNHFG 0.5CM/< | 11305 | $651 |
| HC SHAVE LESN TAL 0.5CM/< | 11300 | $657 |
| HC DSTR BGN LESN 15/> | 17111 | $662 |
| HC ER LEVEL 1 | 99281 | $685 |
| HC MYRINGOTOMY W ASP/EUS TUBE INF | 69420 | $705 |
| HC SHAVE SKIN LESION 0.6-1.0 CM | 11301 | $723 |
| HC ER LEVEL 2 | 99282 | $753 |
| HC IV HYDRAT INIT 31-60 MIN W/HL | 96360 | $852 |
| HC DSTR PREMALG 1ST LESION | 17000 | $852 |
| HC EXCISION CHALAZION SINGLE | 67800 | $965 |
| HC LEVEL 5 SURG PATH GROSS & MICROSCOPIC REF1 | 88307 | $983 |
| HC DSTR BGN LESN 1-14 (ED) | 17110 | $1,009 |
| HC I&D SIMPLE ABSCESS | 10060 | $1,088 |
| HC REMOVE SKN TAGS </=15 LSN | 11200 | $1,224 |
| HC SMP WND RPR TRUNK 2.5CM/< (ED) | 12001 | $1,314 |
| HC EXC CHALAZION MULTI DIFF LIDS | 67805 | $1,378 |
| HC TRABECULOPLASTY LASER SURGERY | 65855 | $1,440 |
| HC ER LEVEL 3 | 99283 | $1,497 |
| Epidural Steroid Injection | 64483 | $1,730 |
| Head CT Scan | 70450 | $1,780 |
| HC EXC LESN FEENLM 0.5CM/< | 11440 | $1,922 |
| HC ARTHRO MAJOR JNT W/O US GUID (ED) | 20610 | $1,969 |
| HC UGI ENDO DIAGNOSTIC COMPLEX | 43235 | $1,997 |
| HC LEVEL 6 SURG PATH GROSS & MICROSCOPIC | 88309 | $2,074 |
| HC ER LEVEL 4 | 99284 | $2,176 |
| Upper Endoscopy with Biopsy | 43239 | $2,243 |
| HC BX BREAST PERC W/O IMAGE | 19100 | $2,375 |
| HC CLSD TX SUBTROCH FEM W/O MAN | 27238 | $2,429 |
| HC EXC LESN TAL 0.5CM/< | 11400 | $2,439 |
| Colonoscopy | 45378 | $2,455 |
| HC EXC LESN TAL 0.6-1.0CM | 11401 | $2,574 |
| Colonoscopy with Biopsy | 45380 | $2,670 |
| Cervical Spine MRI | 72141 | $2,918 |
| Knee MRI | 73721 | $3,039 |
| Lumbar Spine MRI | 72148 | $3,089 |
| HC BIOPSY PROSTATE NEEDLE/PUNCH | 55700 | $3,204 |
| HC ER LEVEL 5 | 99285 | $3,295 |
| HC COLON-SNARE REMOVAL-TUM/POL/LES | 45385 | $3,364 |
| Brain MRI with Contrast | 70553 | $4,507 |
| HC POLYSOM NOCTURNAL 6/>YRS | 95810 | $4,662 |
| Echocardiogram | 93306 | $5,354 |
| HC NASAL/SINUS ENDO SURG W/BX | 31237 | $6,987 |