| Hemoglobin A1c | 83036 | $2 – $257 |
| Complete Blood Count (CBC) | 85025 | $2 – $200 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $4 – $272 |
| TSH Thyroid Test | 84443 | $4 – $404 |
| HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | 82465 | $5 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $6 – $399 |
| HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE | 87491 | $6 |
| Lipid Panel | 80061 | $7 – $255 |
| Comprehensive Metabolic Panel | 80053 | $15 – $541 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $15 – $101 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $16 – $112 |
| Blood Glucose Test | 82947 | $26 – $254 |
| HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE | 86703 | $42 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $46 – $246 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $46 – $120 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $72 – $317 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB | 88312 | $72 – $231 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $84 – $504 |
| Therapeutic Injection | 96372 | $88 |
| HC XR CHEST 1 VIEW | 71045 | $101 – $963 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $106 |
| Chest X-Ray (2 Views) | 71046 | $137 – $1,101 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $191 – $210 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $233 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $290 – $548 |
| HC PSYTX W PT 30 MIN PHP/IOP CDM | 90832 | $307 |
| Mammogram (Screening) | 77067 | $314 – $709 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $321 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $366 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $366 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $366 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $385 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $421 |
| HC PSYTX W PT 45 MIN PHP/IOP CDM | 90834 | $490 |
| DEXA Bone Density Scan | 77080 | $504 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $512 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $568 – $654 |
| HC ED FAC E&M VISIT LEVEL 1 CDM | 99281 | $587 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $756 |
| HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | 10060 | $851 |
| Head CT Scan | 70450 | $874 – $3,571 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $896 |
| Knee X-Ray | 73560 | $989 |
| HC ED FAC E&M VISIT LEVEL 2 CDM | 99282 | $1,094 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $1,276 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $1,314 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $1,314 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $1,314 |
| HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $1,318 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $1,412 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,519 |
| Upper Endoscopy with Biopsy | 43239 | $1,519 |
| HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM | 12001 | $1,728 |
| HC ED FAC E&M VISIT LEVEL 3 CDM | 99283 | $1,925 |
| Colonoscopy | 45378 | $2,242 |
| Echocardiogram | 93306 | $2,472 |
| Cervical Spine MRI | 72141 | $2,483 – $4,538 |
| Knee MRI | 73721 | $2,494 – $5,897 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $2,811 |
| HC ED SEXUAL ASSAULT EXAM CDM | 99284 | $2,831 |
| Lumbar Spine MRI | 72148 | $2,894 – $5,535 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $2,904 |
| Epidural Steroid Injection | 64483 | $3,364 |
| HC ED FAC E&M VISIT LEVEL 5 CDM | 99285 | $4,458 |
| Brain MRI with Contrast | 70553 | $4,687 – $4,780 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $5,760 |