| HC IMMUNIZATION ADMIN CDM | 90471 | $23 |
| HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.5 ML | 90686 | $24 |
| HC PR 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | 82270 | $24 |
| HC PR 99211 OFFICE OUTPATIENT VISIT RHC | 99211 | $25 |
| Complete Blood Count (CBC) | 85025 | $28 |
| HC PR 86580 SKIN TEST TUBERCULOSIS INTRADERMAL | 86580 | $29 |
| Blood Glucose Test | 82947 | $30 |
| HC ASSAY BLD/SERUM CHOLESTEROL | 82465 | $30 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $33 – $44 |
| Comprehensive Metabolic Panel | 80053 | $38 |
| HC PR 99395 SPORT PHYSICAL EST AGE 18-39 | 99395 | $41 |
| EKG (Electrocardiogram) | 93000 | $41 |
| Therapeutic Injection | 96372 | $41 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $46 |
| HC PR 88300 BILL SURG LEVEL 1 | 88300 | $48 |
| Hemoglobin A1c | 83036 | $53 |
| Lipid Panel | 80061 | $56 |
| HC RAPID HIV 1-2 | 86703 | $57 |
| HC PR ADMIN VACCINE INITIAL LTE 18 YEARS OLD CDM | 90460 | $66 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $70 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $70 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM | 87591 | $75 |
| HC CHLAMYDIA AMPLIFICATION APTIMA | 87491 | $75 |
| TSH Thyroid Test | 84443 | $79 |
| HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR | 96360 | $89 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $92 |
| HC PR 88302 BILL SURG LEVEL 2 | 88302 | $96 |
| HC PR 11300 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/OR LESS RHC | 11300 | $97 |
| HC PSYCHOTHERAPY W PT 30 MIN CDM | 90832 | $99 |
| HC PR 99212 OFFICE OUTPATIENT VISIT RHC | 99212 | $101 |
| HC PR 11305 SHAVE SKIN LESION 0.5 CM OR LESS SCLP NK HND FT GEN | 11305 | $107 – $298 |
| HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML | 90750 | $113 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $120 – $159 |
| HC PR 88304 BILL SURG LEVEL 3 | 88304 | $123 |
| HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | 12001 | $129 – $271 |
| HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US RHC | 20610 | $131 |
| HC PR 99202 OFFICE OUTPATIENT NEW RHC | 99202 | $134 |
| HC PR 11301 SHAVE SKIN LESION 0.6 TO 1.0 CM TRNK ARM LEG | 11301 | $148 – $345 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $150 |
| HC PR 17000 DESTRUCTION PREMALIGNANT LESION 1ST RHC | 17000 | $159 |
| HC XR CHEST 1 VIEW | 71045 | $160 |
| Knee X-Ray | 73560 | $162 |
| Psychotherapy (60 min) | 90837 | $172 |
| Office Visit (Established Patient) | 99213 | $189 |
| HC PR 19100 BX BREAST PERCUT W/O IMAGE | 19100 | $197 |
| Chest X-Ray (2 Views) | 71046 | $199 |
| HC PR 17110 DESTRUCTION BENIGN LESIONS UP TO 14 RHC | 17110 | $201 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $203 – $269 |
| Office Visit (New Patient) | 99203 | $205 |
| HC PR 88305 BILL SURG LEVEL 4 | 88305 | $206 |
| HC BILL SURG SPECIAL STAINS GROUP 1 | 88312 | $212 |
| Office Visit (New, Complex) | 99204 | $221 |
| HC PR 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 RHC | 11200 | $224 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $227 |
| HC PSYCHOTHERAPY W PT 45 MIN CDM | 90834 | $234 |
| HC PR 17111 DESTRUCT LESION 15 OR MORE | 17111 | $245 |
| HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS RHC | 11400 | $247 |
| Mammogram (Screening) | 77067 | $265 |
| HC PR 99396 PREVENTIVE VISIT EST 40-64 RHC | 99396 | $267 |
| HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | 99385 | $269 |
| Office Visit (Complex) | 99214 | $278 |
| HC NEW PT VISIT - LEVEL 5 | 99205 | $281 |
| HC PR 11401 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM RHC | 11401 | $308 |
| HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE RHC | 10060 | $311 |
| HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS | 11440 | $313 – $410 |
| HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | 99386 | $326 |
| HC PR 88323 BILL SURG CONSULT BLOCKS | 88323 | $334 |
| DEXA Bone Density Scan | 77080 | $343 |
| HC PR ED 99284 VISIT MODERATE MDM CDM | 99284 | $346 – $458 |
| HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | 43235 | $350 – $820 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $353 |
| HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH CDM | 55700 | $371 |
| Upper Endoscopy with Biopsy | 43239 | $394 – $1,060 |
| HC PSYCH DIAG EVAL CDM | 90791 | $401 |
| HC PR 99215 OFFICE OUTPATIENT VISIT RHC | 99215 | $412 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $501 – $665 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $516 |
| Colonoscopy | 45378 | $526 – $973 |
| Echocardiogram | 93306 | $558 |
| HC BILL SURG LEVEL 5 | 88307 | $567 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $571 |
| Colonoscopy with Biopsy | 45380 | $572 – $1,231 |
| HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | 45385 | $721 – $1,292 |
| HC PR 31237 NASAL/SINUS ENDOSCOPY SURG W/ BIOPSY | 31237 | $764 |
| HC BILL SURG LEVEL 6 | 88309 | $766 |
| Head CT Scan | 70450 | $779 |
| Knee MRI | 73721 | $1,310 |
| HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | 29881 | $1,598 |
| Lumbar Spine MRI | 72148 | $1,616 |
| HC PR 44970 LAPAROSCOPY APPENDECTOMY | 44970 | $1,756 |
| Cervical Spine MRI | 72141 | $1,808 |
| HC PR ED 27238 CLD TX INTER/PERI/OR SUB-TROCHANTERIC THIGH FX W/O MANIP CDM | 27238 | $1,848 |
| HC PR 19301 PARTIAL MASTECTOMY | 19301 | $1,921 |
| Laparoscopic Cholecystectomy | 47562 | $1,926 |
| HC PR 52601 PROSTATECTOMY (TURP) | 52601 | $2,099 |
| HC POLYSOMNOGRAPHY 4 OR MORE | 95810 | $2,148 |
| Brain MRI with Contrast | 70553 | $2,318 |
| HC PR 58260 VAGINAL HYSTERECTOMY | 58260 | $2,425 |
| HC PR 19302 P-MASTECTOMY W/LN REMOVAL | 19302 | $2,639 |
| HC PR 19303 MAST SIMPLE COMPLETE | 19303 | $2,791 |
| HC PR 58552 LAPARO-VAGINAL HYSTERECTOMY INCL TUBES/OVARY(S) | 58552 | $2,839 |
| HC PR 29888 KNEE ARTHRO/SURG | 29888 | $2,842 |
| HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM | 58150 | $2,948 |
| Shoulder Arthroscopy | 29827 | $3,117 |
| HC PR 19307 MAST MOD RAD | 19307 | $3,428 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $3,441 |
| HC PR 27236 OPEN TX THIGH FRACTURE W/O MANIP | 27236 | $3,480 |
| Total Knee Replacement | 27447 | $3,733 |
| Total Hip Replacement | 27130 | $3,737 |
| HC PR 27486 REVSN TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT CDM | 27486 | $4,090 |
| HC PR 27487 REVSN TOTAL KNEE ARTHRP W/WO ALGRFT FEM&ENTIRE TIBIAL CMPNT CDM | 27487 | $5,088 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $7,055 |