| HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.5 ML | 90686 | $13 |
| HC ADMIN HEPATITIS B VACCINE CDM | 90471 | $16 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $35 |
| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $40 |
| HC CHOLESTEROL | 82465 | $41 |
| HC PR 88312 BILL SURG STAINS GROUP 1 | 88312 | $46 |
| HC CELL BLOCK | 88305 | $49 |
| HC SKIN TEST TUBERCULOSIS INTRADERMAL CDM | 86580 | $52 – $222 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $55 |
| Blood Glucose Test | 82947 | $66 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | 87491 | $67 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $67 – $141 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $67 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $74 |
| Lipid Panel | 80061 | $78 |
| Complete Blood Count (CBC) | 85025 | $82 |
| HC PR 90832 PSYTX W PT 30 MIN RHC | 90832 | $97 |
| Hemoglobin A1c | 83036 | $114 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $120 – $194 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $120 – $196 |
| Chest X-Ray (2 Views) | 71046 | $124 – $574 |
| HC XR CHEST 1 VIEW | 71045 | $124 – $365 |
| TSH Thyroid Test | 84443 | $127 |
| HC PR 90834 PSYTX W PT 45 MIN RHC | 90834 | $146 |
| Therapeutic Injection | 96372 | $149 – $205 |
| Knee X-Ray | 73560 | $162 – $802 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $162 – $720 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $168 |
| HC HIV-1/HIV-2 SINGLE ASSAY | 86703 | $168 |
| Comprehensive Metabolic Panel | 80053 | $183 |
| Psychotherapy (60 min) | 90837 | $193 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $200 – $312 |
| HC CRISIS PHONE 99211 LACTATION EDUCATION ESTAB PT VISIT CDM | 99211 | $202 |
| HC CRISIS PHONE 99212 LACTATION EDUCATION ESTAB PT VISIT CDM | 99212 | $224 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $280 |
| HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM | 11300 | $320 |
| HC DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $320 |
| HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | 12001 | $320 – $463 |
| HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/OR LESS CDM | 11305 | $320 |
| Office Visit (Established Patient) | 99213 | $321 |
| HC ED OB FAC E&M VISIT LEVEL 1 CDM | 99281 | $335 |
| Head CT Scan | 70450 | $347 – $1,222 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $356 – $578 |
| Office Visit (Complex) | 99214 | $384 |
| HC PR 90791 PSYCH DIAG EVAL RHC | 90791 | $384 |
| HC MICROSLIDE CONSULTATION W/ SLIDE PREP | 88323 | $391 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $394 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $448 |
| DEXA Bone Density Scan | 77080 | $510 |
| HC ED OB FAC E&M VISIT LEVEL 2 CDM | 99282 | $541 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $566 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $580 |
| HC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | 10060 | $608 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $658 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $662 |
| Cervical Spine MRI | 72141 | $730 – $2,958 |
| Lumbar Spine MRI | 72148 | $758 – $3,532 |
| Knee MRI | 73721 | $758 – $2,808 |
| HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $771 – $824 |
| HC ED OB FAC E&M VISIT LEVEL 3 CDM | 99283 | $800 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $1,216 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $1,216 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $1,216 |
| Echocardiogram | 93306 | $1,219 – $1,649 |
| Brain MRI with Contrast | 70553 | $1,219 – $3,856 |
| HC ED OB FAC E&M VISIT LEVEL 4 CDM | 99284 | $1,286 |
| Epidural Steroid Injection | 64483 | $1,548 |
| Upper Endoscopy with Biopsy | 43239 | $1,610 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,610 |
| Colonoscopy | 45378 | $1,621 |
| HC POLYSOMNOGRAPHY 4 OR MORE | 95810 | $1,698 – $3,245 |
| HC ED OB FAC E&M VISIT LEVEL 5 CDM | 99285 | $2,850 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $3,445 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $7,060 |