| HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL LAB | 82465 | $20 |
| Blood Glucose Test | 82947 | $20 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $23 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $24 |
| Complete Blood Count (CBC) | 85025 | $32 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $35 |
| Hemoglobin A1c | 83036 | $37 |
| TSH Thyroid Test | 84443 | $41 |
| Comprehensive Metabolic Panel | 80053 | $43 |
| Lipid Panel | 80061 | $59 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $62 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $62 |
| HC RAPID HIV 1-2 | 86703 | $74 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $79 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $81 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM | 87591 | $85 |
| HC CHLAMYDIA AMPLIFICATION APTIMA | 87491 | $85 |
| HC CRISIS PHONE 99211 LACTATION EDUCATION ESTAB PT VISIT CDM | 99211 | $88 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $95 |
| HC PR 88304 BILL SURG LEVEL 3 | 88304 | $116 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $142 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $150 |
| Therapeutic Injection | 96372 | $152 |
| Office Visit (Established Patient) | 99213 | $176 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $188 |
| HC PR 88305 BILL SURG LEVEL 4 | 88305 | $194 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $221 |
| HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | 12001 | $239 |
| HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | 20610 | $239 |
| Office Visit (New Patient) | 99203 | $246 |
| Office Visit (Complex) | 99214 | $257 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $260 |
| HC BILL SURG SPECIAL STAINS GROUP 1 | 88312 | $260 |
| HC XR CHEST 1 VIEW | 71045 | $283 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $287 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $300 |
| HC PR 88323 BILL SURG CONSULT BLOCKS | 88323 | $311 |
| Knee X-Ray | 73560 | $318 |
| Mammogram (Screening) | 77067 | $338 |
| Chest X-Ray (2 Views) | 71046 | $359 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $380 |
| Office Visit (New, Complex) | 99204 | $395 |
| HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | 11400 | $448 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $479 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $479 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $479 |
| DEXA Bone Density Scan | 77080 | $493 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $497 |
| Echocardiogram | 93306 | $533 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $553 |
| HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | 10060 | $560 |
| HC PR ED 11401 EXC TR-EXT B9+MARG 0.6-1 CM CDM | 11401 | $566 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $599 |
| HC PR ED 99284 VISIT MODERATE MDM CDM | 99284 | $639 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $803 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $833 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $930 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $1,036 |
| Head CT Scan | 70450 | $1,523 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,548 |
| Upper Endoscopy with Biopsy | 43239 | $1,548 |
| Colonoscopy | 45378 | $1,559 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $1,724 |
| Knee MRI | 73721 | $1,988 |
| Cervical Spine MRI | 72141 | $2,087 |
| Epidural Steroid Injection | 64483 | $2,099 |
| Lumbar Spine MRI | 72148 | $2,276 |
| HC PR ED 27238 CLD TX INTER/PERI/OR SUB-TROCHANTERIC THIGH FX W/O MANIP CDM | 27238 | $2,535 |
| HC POLYSOMNOGRAM REDUCED SERVICE | 95810 | $3,101 |
| HC BIOPSY OF PROSTATE | 55700 | $3,661 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $3,689 |
| Brain MRI with Contrast | 70553 | $4,567 |
| Total Hip Replacement | 27130 | $6,853 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $7,562 |