| HC 99211 PRO TCS VISIT EST PT LEVEL I | 99211 | $13 |
| HC SKIN TEST - TUBERCULOSIS, INTRADERMAL | 86580 | $27 |
| TSH Thyroid Test | 84443 | $29 |
| HC URINALYSIS, AUTO W/SCOPE | 81001 | $32 |
| HC 99212 PRO OUTPATIENT VISIT, ESTABLISHED PATIENT, LEVEL II | 99212 | $32 |
| HC PREVENT MED COMPRE EST,40-64 AGE B | 99396 | $39 |
| HC IMMUNIZATION ADMINISTRAT, ONE VACCINE | 90471 | $42 |
| Therapeutic Injection | 96372 | $42 |
| HC PREVENT MED COMPRE EST, 18-39 AGE A | 99395 | $47 |
| HC CA SCREEN, OCCULT BLOOD, 1-3 DETERM | 82270 | $48 – $49 |
| Office Visit (Established Patient) | 99213 | $49 |
| HC 99202 PRO OUTPATIENT VISIT, NEW PATIENT, LEVEL II | 99202 | $53 |
| HC SO MCRNA, C TRACH, MISC, AMPLIFIED RNA, MCTGC | 87491 | $53 |
| HC SO MGRNA, N GONORR, MISC, AMPLIFIED RNA, MCTGC | 87591 | $53 |
| HC SFMC FUNG SILVER STAIN LAB TEST | 88312 | $59 |
| HC CHOLESTEROL, SERUM, TOTAL | 82465 | $63 |
| Hemoglobin A1c | 83036 | $70 |
| Blood Glucose Test | 82947 | $71 |
| Office Visit (Complex) | 99214 | $77 |
| Office Visit (New Patient) | 99203 | $79 |
| HC SURG PATH LEVEL I, GROSS ONLY | 88300 | $84 – $85 |
| Complete Blood Count (CBC) | 85025 | $92 – $133 |
| HC PREVENT MED COMPRE NEW, 18-39 AGE B | 99385 | $93 |
| HC PREVENT MED COMPRE NEW, 40-64 AGE B | 99386 | $93 |
| HC 11200 RMVL OF SKIN TAG UP TO 15 LESIONS | 11200 | $115 |
| HC SHAVING TRK/ARM/LEG, 0.6 TO 1.0 | 11301 | $115 |
| HC SHAVING LES OTHER <=.5CM | 11305 | $115 |
| HC DEST WART BENIGN LESION 1ST | 17000 | $115 |
| HC 99215 PRO OUTPATIENT VISIT, ESTABLISHED PATIENT, LEVEL V | 99215 | $117 |
| HC 17110 PRO DESTRUCTION OF BENIGN LESIONS; UP TO 14 LESIONS | 17110 | $121 |
| HC LEVEL II SURG PATH GROSS & MICRO | 88302 | $124 – $124 |
| HC SCAN COMP OPTH DX IMAGING, POST RETINA W/ I & R | 92134 | $129 |
| Office Visit (New, Complex) | 99204 | $134 |
| HC 96360 IV INF,HYDR;INIT 31 MIN TO 1 HOUR | 96360 | $137 |
| HC INF AGENT,DNA OR RNA; HPV HIGH-RISK TYPES | 87624 | $142 – $143 |
| HC DEST FLAT WART/MOLLUS/MILIA 14+ | 17111 | $145 |
| HC 12001 SIM REP,SLP,NCK,AXL,TRK,EXT<=2.5 | 12001 | $152 |
| Lipid Panel | 80061 | $161 – $203 |
| HC 99205 PRO OUTPATIENT VISIT, NEW PATIENT, LEVEL V | 99205 | $171 |
| HC 10060 INC/DRN ABCSS/CYST SMPL SINGLE | 10060 | $173 |
| HC 90832 PSYCHOTHERAPY 30 MIN W/PT | 90832 | $175 |
| HC ANTIBODY; HIV-1 & HIV-2, SINGLE | 86703 | $183 – $184 |
| HC LAB PSA TOTAL | 84153 | $183 – $184 |
| HC VISUAL FIELD EXAMINATION | 92083 | $187 |
| HC FROZEN SECTION | 88331 | $191 – $192 |
| HC 99281 ED VISIT LEVEL I | 99281 | $201 |
| HC LEVEL III SURG PATH GROSS & MICRO ONLY | 88304 | $203 – $203 |
| DEXA Bone Density Scan | 77080 | $217 – $218 |
| HC EXC BEN LES TRK/ARM/LEG .6 TO 1CM | 11401 | $221 |
| HC SHAVING TRK/ARM/LG, <= 0.5 | 11300 | $221 |
| Comprehensive Metabolic Panel | 80053 | $223 – $298 |
| HC 71045 CHEST SINGLE VIEW | 71045 | $236 |
| HC 77081 BC-DEXA,1 OR MORE SITES,APNDIC SKELETON | 77081 | $240 – $241 |
| HC 90834 PRO PSYCHOTHERAPY 45 MIN W/PT | 90834 | $241 |
| HC 90791 PRO PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $241 |
| Psychotherapy (60 min) | 90837 | $241 |
| Knee X-Ray | 73560 | $268 – $270 |
| Mammogram (Screening) | 77067 | $275 |
| Chest X-Ray (2 Views) | 71046 | $280 |
| HC 73030 SHOULDER COMPLETE, MIN 2V-LT | 73030 | $321 – $322 |
| HC LEVEL IV SURG PATH GROSS & MICRO | 88305 | $376 – $377 |
| HC 20610 INJ ARTHRO, MAJOR JT/BURSA/GAN; WO US GUIDE | 20610 | $397 |
| HC EXC BEN LES HEAD <=.5CM | 11440 | $397 |
| HC 99282 ED VISIT, LEVEL II | 99282 | $418 |
| HC LEVEL V SURG PATH GROSS & MICRO ONLY | 88307 | $467 – $469 |
| HC EXC BEN LES TRK/ARM/LEG <=.5CM | 11400 | $472 |
| Colonoscopy | 45378 | $533 |
| HC CONSULT & RPT ON REF MATER W SLIDES | 88323 | $539 – $542 |
| HC EGD, TRANSORAL DIAG W/SPEC COLL | 43235 | $544 |
| HC LEVEL VI SURG PATH GROSS & MICRO ONLY | 88309 | $686 – $696 |
| HC 99283 ED VISIT, LEVEL III | 99283 | $713 |
| Upper Endoscopy with Biopsy | 43239 | $806 |
| HC TRABECULOPLASTY BY LASER SURGERY | 65855 | $875 |
| HC 95810 POLYSOMNOGRAPHY, 4 OR > PARAM | 95810 | $963 |
| HC 27238 CLSD TROCHAN FEMORAL FX,W/O MANIP RT | 27238 | $1,008 |
| Epidural Steroid Injection | 64483 | $1,038 |
| HC 99284 ED VISIT, LEVEL IV | 99284 | $1,130 |
| Echocardiogram | 93306 | $1,853 |
| HC 99285 ED VISIT, LEVEL V | 99285 | $1,878 |
| Head CT Scan | 70450 | $2,037 |
| HC 19100 BX BREAST NEEDLE CORE W/O IMAGING | 19100 | $2,155 |
| HC 95808 POLYSOMNOGRAPH, 1-3 ADD PARAM-REDUCE | 95808 | $2,663 |
| HC NASAL/SINUS ENDOSCOPY, SURGICAL; W BIOPSY, POLYPECTOMY OR DEBRIDEMENT | 31237 | $2,720 |
| Cervical Spine MRI | 72141 | $2,871 |
| Lumbar Spine MRI | 72148 | $2,871 |
| Knee MRI | 73721 | $2,871 |
| Brain MRI with Contrast | 70553 | $3,325 |