| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $1 |
| Office Visit (Complex) | 99214 | $1 |
| HC PR 99211 ESTAB PT VISIT - LEVEL 1 | 99211 | $1 |
| HC DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $1 |
| HC PR 99205 NEW PT VISIT - LEVEL 5 | 99205 | $1 |
| HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | 12001 | $1 |
| HC PREV VISIT EST AGE 40-64 | 99396 | $1 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $1 |
| HC PREV VISIT NEW AGE 18-39 | 99385 | $1 |
| HC PREV VISIT EST AGE 18-39 | 99395 | $1 |
| HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE CDM | 10060 | $1 |
| HC DESTRUCTION PREMALIGNANT LESION 1ST CDM | 17000 | $1 |
| HC PREV VISIT NEW AGE 40-64 | 99386 | $1 |
| HC PR ADMIN VACCINE INITIAL CDM | 90471 | $1 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $1 |
| Office Visit (New, Complex) | 99204 | $1 |
| Office Visit (New Patient) | 99203 | $1 |
| Office Visit (Established Patient) | 99213 | $1 |
| Hemoglobin A1c | 83036 | $12 |
| Lipid Panel | 80061 | $15 |
| TSH Thyroid Test | 84443 | $17 |
| HC CHOLESTEROL TOTAL | 82465 | $18 |
| Blood Glucose Test | 82947 | $18 |
| Complete Blood Count (CBC) | 85025 | $18 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | 84153 | $25 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | 87491 | $27 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | 87591 | $27 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $36 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES | 87624 | $38 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | 81001 | $46 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $50 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $60 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $72 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $74 |
| HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | 20610 | $81 |
| EKG (Electrocardiogram) | 93000 | $84 |
| HC HIV-1/HIV-2 SINGLE ASSAY | 86703 | $95 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $107 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $124 |
| HC SPECIAL STAINS GRP I TC | 88312 | $124 |
| Comprehensive Metabolic Panel | 80053 | $127 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $129 |
| HC MICROSLIDE CONSULTATION W/ SLIDE PREP | 88323 | $141 |
| HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | 11400 | $141 |
| Therapeutic Injection | 96372 | $146 |
| HC PR 11300 SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG | 11300 | $158 |
| HC PR 11200 REMOVAL OF SKIN TAGS | 11200 | $161 |
| HC BILL SURG SLIDE PREP | 88305 | $175 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $180 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $185 |
| HC PR ED 99284 VISIT MODERATE MDM CDM | 99284 | $206 |
| HC XR CHEST 1 VIEW | 71045 | $237 – $374 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $301 |
| Chest X-Ray (2 Views) | 71046 | $313 – $489 |
| Knee X-Ray | 73560 | $321 – $505 |
| Mammogram (Screening) | 77067 | $337 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $363 – $569 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $368 |
| DEXA Bone Density Scan | 77080 | $371 – $582 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $372 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $372 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $390 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $401 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $508 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $543 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $818 |
| Head CT Scan | 70450 | $968 – $1,210 |
| Knee MRI | 73721 | $1,233 |
| HC POLYSOMNOGRAPHY 1-3 | 95808 | $1,599 |
| HC POLYSOMNOGRAM REDUCED SERVICE | 95810 | $1,705 |
| Cervical Spine MRI | 72141 | $1,733 |
| Echocardiogram | 93306 | $1,771 – $2,479 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,984 |
| Upper Endoscopy with Biopsy | 43239 | $2,046 |
| Colonoscopy | 45378 | $2,173 |
| Brain MRI with Contrast | 70553 | $2,258 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $2,325 |
| Lumbar Spine MRI | 72148 | $2,706 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $3,344 |
| Epidural Steroid Injection | 64483 | $3,542 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $3,787 |
| HC BIOPSY OF PROSTATE | 55700 | $3,922 |