| HC PR 99211 LACTATION CONSULT 30 MIN | 99211 | $14 – $34 |
| HC SKIN TEST TUBERCULOSIS INTRADERMAL CDM | 86580 | $14 |
| HC OCCULT BLOOD FECES | 82270 | $14 |
| HC PR ADMIN VACCINE INITIAL CDM | 90471 | $17 |
| HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.5 ML | 90686 | $18 |
| Therapeutic Injection | 96372 | $22 |
| EKG (Electrocardiogram) | 93000 | $22 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $32 |
| HC PR ADMIN VACCINE INITIAL LTE 18 YEARS OLD CDM | 90460 | $34 |
| HC CHOLESTEROL | 82465 | $35 |
| Blood Glucose Test | 82947 | $35 |
| Hemoglobin A1c | 83036 | $37 |
| Complete Blood Count (CBC) | 85025 | $41 |
| HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR RHC | 96360 | $46 |
| HC PR 11300 SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG | 11300 | $50 – $152 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $53 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $53 – $82 |
| DEXA Bone Density Scan | 77080 | $55 |
| HC PR 11305 SHAVE SKIN LESION 0.5 CM OR LESS SCLP NK HND FT GEN | 11305 | $56 – $160 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $62 |
| HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | 20610 | $66 – $96 |
| HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | 12001 | $66 – $139 |
| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $71 – $106 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | 87591 | $73 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | 87491 | $73 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $74 |
| TSH Thyroid Test | 84443 | $74 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC | 88331 | $74 |
| HC PR 11301 SHAVE SKIN LESION 0.6 TO 1.0 CM TRNK ARM LEG | 11301 | $74 – $182 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $79 |
| HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION | 17000 | $80 – $99 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $82 |
| HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE | 86703 | $86 |
| Office Visit (Established Patient) | 99213 | $88 |
| HC BILL SURG SPECIAL STAINS GROUP 1 | 88312 | $90 |
| Lipid Panel | 80061 | $90 |
| Office Visit (Complex) | 99214 | $92 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $95 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $96 |
| HC PR 17110 DESTRUCT B9 LESION 1-14 | 17110 | $97 – $167 |
| HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | 90832 | $99 – $112 |
| HC PR 19100 BX BREAST PERCUT W/O IMAGE | 19100 | $102 – $231 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $105 |
| HC PR 11200 REMOVAL OF SKIN TAGS | 11200 | $110 – $133 |
| Comprehensive Metabolic Panel | 80053 | $114 |
| Office Visit (New Patient) | 99203 | $115 |
| HC PR 17111 DESTRUCT LESION 15 OR MORE | 17111 | $118 – $196 |
| HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | 11400 | $122 – $190 |
| HC PR 99395 PREVENTIVE VISIT EST 18-39 RHC | 99395 | $127 – $175 |
| HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | 90834 | $130 – $148 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $133 |
| HC PR 99396 PREVENTIVE VISIT EST 40-64 RHC | 99396 | $139 – $186 |
| HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | 99385 | $141 – $194 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | 84153 | $143 |
| HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML | 90750 | $145 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $145 |
| Epidural Steroid Injection | 64483 | $146 |
| HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | 10060 | $153 – $183 |
| HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS | 11440 | $154 – $213 |
| HC PR ED 11401 EXC TR-EXT B9+MARG 0.6-1 CM CDM | 11401 | $154 – $232 |
| HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | 99386 | $170 – $223 |
| HC PR ED 99284 VISIT MODERATE MDM CDM | 99284 | $177 |
| HC PR 69420 INCISION OF EARDRUM W/O GENERAL ANESTHESIA BILATERAL | 69420 | $177 – $284 |
| HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | 43235 | $178 – $451 |
| HC XR CHEST 1 VIEW | 71045 | $183 |
| Psychotherapy (60 min) | 90837 | $191 – $217 |
| Knee X-Ray | 73560 | $192 |
| HC PR 67800 EXCISION CHALAZION SINGLE RHC | 67800 | $192 |
| Office Visit (New, Complex) | 99204 | $196 – $243 |
| Upper Endoscopy with Biopsy | 43239 | $201 – $578 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $211 – $262 |
| HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $221 – $257 |
| HC PR 30801 ABLATION INFERIOR TURBINATES SUPERFICIAL | 30801 | $229 – $330 |
| Chest X-Ray (2 Views) | 71046 | $231 |
| HC PR 31237 NASAL/SINUS ENDOSCOPY SURG W/ BIOPSY | 31237 | $233 – $379 |
| HC PR 69436 CREATE EARDRUM OPENING GENERAL ANESTHESIA BILATERAL | 69436 | $234 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $239 |
| HC NEW PT VISIT - LEVEL 5 | 99205 | $255 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $257 |
| HC PR 30140 RESECT INFERIOR TURBINATE | 30140 | $260 – $441 |
| Colonoscopy | 45378 | $268 – $512 |
| Mammogram (Screening) | 77067 | $283 |
| Echocardiogram | 93306 | $289 |
| Colonoscopy with Biopsy | 45380 | $291 – $660 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $337 |
| HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH RHC | 55700 | $358 |
| HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | 45385 | $370 – $686 |
| HC PR 42826 REMOVAL OF TONSILS >12YEARS | 42826 | $375 |
| HC PR 42825 REMOVAL OF TONSILLS PRIMARY OR SECONDARY/YOUNGER THAN 12 YRS | 42825 | $394 |
| HC PR 42820 REMOVAL OF TONSILLS AND ADENOIDS/YOUNGER THAN 12 YRS | 42820 | $427 |
| HC PR 42821 REMOVE TONSILS AND ADENOIDS > 12 YEARS | 42821 | $446 |
| Head CT Scan | 70450 | $830 |
| HC PR 44970 LAPAROSCOPY APPENDECTOMY | 44970 | $894 |
| HC PR 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND RHC | 95810 | $934 |
| HC PR 44950 APPENDECTOMY | 44950 | $952 |
| HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | 29881 | $960 |
| HC PR 19301 PARTIAL MASTECTOMY | 19301 | $979 |
| Laparoscopic Cholecystectomy | 47562 | $981 |
| HC PR 30520 REPAIR OF NASAL SEPTUM | 30520 | $1,008 |
| HC PR 58260 VAGINAL HYSTERECTOMY | 58260 | $1,240 |
| HC PR 44960 APPENDECTOMY, RUPTURED | 44960 | $1,302 |
| HC PR 19302 P-MASTECTOMY W/LN REMOVAL | 19302 | $1,345 |
| HC PR 19303 MAST SIMPLE COMPLETE | 19303 | $1,419 |
| HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR | 29888 | $1,438 |
| HC PR 58552 LAPARO-VAGINAL HYSTERECTOMY INCL TUBES/OVARY(S) | 58552 | $1,446 |
| HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM | 58150 | $1,491 |
| Shoulder Arthroscopy | 29827 | $1,574 |
| Cervical Spine MRI | 72141 | $1,691 |
| Knee MRI | 73721 | $1,724 |
| HC PR 19307 MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN RHC | 19307 | $1,750 |
| HC PR 27236 OPEN TX THIGH FRACTURE W/O MANIP | 27236 | $1,754 |
| Total Knee Replacement | 27447 | $1,884 |
| Total Hip Replacement | 27130 | $1,886 |
| Lumbar Spine MRI | 72148 | $1,957 |
| HC PR 27486 REVSN TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT CDM | 27486 | $2,062 |
| Brain MRI with Contrast | 70553 | $2,817 |