| Hemoglobin A1c | 83036 | $2 – $52 |
| Complete Blood Count (CBC) | 85025 | $2 – $84 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $3 – $59 |
| TSH Thyroid Test | 84443 | $4 – $90 |
| HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | 82465 | $5 |
| HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE | 87491 | $6 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $6 |
| Lipid Panel | 80061 | $6 – $108 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R | 88312 | $8 – $34 |
| Comprehensive Metabolic Panel | 80053 | $11 – $59 |
| HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE | 86703 | $21 – $39 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $30 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $37 |
| Blood Glucose Test | 82947 | $59 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $60 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $68 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $90 |
| Therapeutic Injection | 96372 | $96 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $96 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $98 |
| HC XR CHEST 1 VIEW | 71045 | $116 – $357 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $127 |
| HC CD IOP TX IND PT 30MIN | 90832 | $144 |
| HC PSYCH DIAG EVAL PHP/IOP CDM | 90791 | $159 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $192 |
| HC CD IOP TX IND PT 45MIN | 90834 | $213 |
| Psychotherapy (60 min) | 90837 | $281 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $287 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $288 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $293 |
| HC ED SEXUAL ASSAULT EXAM CDM | 99284 | $332 |
| Knee X-Ray | 73560 | $348 |
| HC ED FAC E&M VISIT LEVEL 1 CDM | 99281 | $390 |
| Chest X-Ray (2 Views) | 71046 | $443 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $444 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $475 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $487 |
| DEXA Bone Density Scan | 77080 | $521 |
| Mammogram (Screening) | 77067 | $580 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $637 |
| HC ED FAC E&M VISIT LEVEL 2 CDM | 99282 | $709 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $887 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $919 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $919 |
| HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | 10060 | $968 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $968 |
| Head CT Scan | 70450 | $1,018 – $1,587 |
| HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | 12001 | $1,056 |
| HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $1,105 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $1,153 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $1,153 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $1,196 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $1,196 |
| Colonoscopy | 45378 | $1,204 |
| Epidural Steroid Injection | 64483 | $1,315 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,352 |
| Upper Endoscopy with Biopsy | 43239 | $1,352 |
| HC POLYSOMNOGRAPHY 4 OR MORE | 95810 | $1,383 |
| Cervical Spine MRI | 72141 | $1,594 – $2,493 |
| HC ED FAC E&M VISIT LEVEL 3 CDM | 99283 | $1,667 |
| Lumbar Spine MRI | 72148 | $1,778 – $2,634 |
| Knee MRI | 73721 | $1,790 – $2,653 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $1,829 |
| Echocardiogram | 93306 | $1,972 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $2,241 |
| Brain MRI with Contrast | 70553 | $3,137 – $4,906 |
| HC ED FAC E&M VISIT LEVEL 5 CDM | 99285 | $3,333 |
| HC BIOPSY OF PROSTATE | 55700 | $3,636 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $4,804 |