| Hemoglobin A1c | 83036 | $2 – $57 |
| Complete Blood Count (CBC) | 85025 | $2 – $78 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $3 – $94 |
| TSH Thyroid Test | 84443 | $4 – $86 |
| HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | 82465 | $5 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $6 – $67 |
| HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE | 87491 | $6 |
| Lipid Panel | 80061 | $6 – $88 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R | 88312 | $8 – $34 |
| Comprehensive Metabolic Panel | 80053 | $11 – $105 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $24 |
| HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE | 86703 | $39 |
| Blood Glucose Test | 82947 | $45 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $61 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $64 |
| Therapeutic Injection | 96372 | $84 |
| Knee X-Ray | 73560 | $94 – $338 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $97 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $124 |
| HC XR CHEST 1 VIEW | 71045 | $132 – $751 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $143 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $144 – $517 |
| HC CD PHP TX IND PT 30MIN | 90832 | $165 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $170 |
| Chest X-Ray (2 Views) | 71046 | $194 – $767 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $195 |
| HC CD PHP TX IND PT 45MIN | 90834 | $213 |
| HC PSYCH DIAG EVAL IOP CDM | 90791 | $214 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $224 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $235 |
| Psychotherapy (60 min) | 90837 | $255 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $313 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $332 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $332 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $342 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $355 |
| HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | 12001 | $369 |
| HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $377 |
| HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | 10060 | $395 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $396 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $396 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $501 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $536 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $551 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $565 |
| Mammogram (Screening) | 77067 | $576 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $581 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $581 |
| HC ED FAC E&M VISIT LEVEL 1 CDM | 99281 | $636 |
| Colonoscopy | 45378 | $1,045 |
| Epidural Steroid Injection | 64483 | $1,046 |
| HC ED FAC E&M VISIT LEVEL 2 CDM | 99282 | $1,058 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,076 |
| Upper Endoscopy with Biopsy | 43239 | $1,076 |
| Head CT Scan | 70450 | $1,317 – $1,435 |
| HC POLYSOMNOGRAPHY 4 OR MORE | 95810 | $1,543 |
| Echocardiogram | 93306 | $1,577 |
| HC ED FAC E&M VISIT LEVEL 3 CDM | 99283 | $1,705 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $1,738 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $2,123 |
| Knee MRI | 73721 | $2,249 – $4,975 |
| HC ED FAC E&M VISIT LEVEL 4 CDM | 99284 | $2,534 |
| Lumbar Spine MRI | 72148 | $2,603 – $5,754 |
| HC BIOPSY OF PROSTATE | 55700 | $2,825 |
| Cervical Spine MRI | 72141 | $3,097 – $6,849 |
| HC ED FAC E&M VISIT LEVEL 5 CDM | 99285 | $3,520 |
| Brain MRI with Contrast | 70553 | $3,660 – $7,492 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $4,122 |