| HC PR 99211 ESTAB PT VISIT - LEVEL 1 | 99211 | $19 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $28 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $32 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | 87491 | $34 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $41 |
| HC PR 88312 BILL SURG STAINS GROUP 1 | 88312 | $46 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM | 81001 | $47 |
| Therapeutic Injection | 96372 | $48 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $55 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $55 |
| Lipid Panel | 80061 | $60 |
| HC PR 88305 TISSUE EXAM BY PATHOLOGIST | 88305 | $64 |
| Blood Glucose Test | 82947 | $69 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $75 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $76 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $78 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $80 |
| HC PR ED 20610 DRAIN/INJ JOINT/BURSA W/O US CDM | 20610 | $81 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $88 |
| HC MICROSLIDE CONSULTATION W/ SLIDE PREP | 88323 | $92 |
| Comprehensive Metabolic Panel | 80053 | $92 |
| Hemoglobin A1c | 83036 | $92 |
| Complete Blood Count (CBC) | 85025 | $96 |
| HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | 12001 | $100 |
| Office Visit (Established Patient) | 99213 | $100 |
| HC CHOLESTEROL | 82465 | $102 |
| TSH Thyroid Test | 84443 | $113 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $120 |
| HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | 10060 | $127 |
| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $127 |
| HC BILL SURG LEVEL 2 | 88302 | $128 |
| HC TB INTRADERMAL TEST - PPD | 86580 | $141 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $146 |
| Office Visit (Complex) | 99214 | $153 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $160 |
| Office Visit (New Patient) | 99203 | $185 |
| HC PR ED 99284 VISIT MODERATE MDM CDM | 99284 | $224 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $232 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $244 |
| HC XR CHEST 1 VIEW | 71045 | $254 |
| HC SURGICAL PATHOLOGY V TC | 88307 | $264 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $270 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $270 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $270 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $271 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $278 |
| Mammogram (Screening) | 77067 | $280 |
| Office Visit (New, Complex) | 99204 | $282 |
| HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | 43235 | $298 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $310 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $327 |
| Knee X-Ray | 73560 | $328 |
| Chest X-Ray (2 Views) | 71046 | $329 |
| HC PR 99205 NEW PT VISIT - LEVEL 5 | 99205 | $349 |
| Upper Endoscopy with Biopsy | 43239 | $351 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $390 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $421 |
| Colonoscopy | 45378 | $443 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $455 |
| Colonoscopy with Biopsy | 45380 | $530 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $535 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $558 |
| HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | 45385 | $629 |
| Echocardiogram | 93306 | $854 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $971 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $971 |
| Head CT Scan | 70450 | $1,033 |
| HC BIOPSY OF PROSTATE | 55700 | $1,145 |
| Cervical Spine MRI | 72141 | $2,022 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $2,076 |
| Knee MRI | 73721 | $2,090 |
| Lumbar Spine MRI | 72148 | $2,202 |
| Brain MRI with Contrast | 70553 | $3,644 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $4,257 |