| Hemoglobin A1c | 83036 | $2 – $145 |
| Complete Blood Count (CBC) | 85025 | $2 – $136 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | 84153 | $4 – $181 |
| TSH Thyroid Test | 84443 | $4 – $254 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $5 – $100 |
| HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL | 82465 | $5 |
| HC OCCULT BLOOD FECES | 82270 | $5 |
| HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE | 87491 | $6 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | 87591 | $6 – $471 |
| Lipid Panel | 80061 | $7 – $336 |
| HC PR 99211 OFFICE OUTPATIENT VISIT RHC | 99211 | $14 |
| Comprehensive Metabolic Panel | 80053 | $15 – $271 |
| HC PR ADMIN VACCINE INITIAL LTE 18 YEARS OLD VFC CDM | 90460 | $16 |
| HC PR RX INFLUENZA QUADRIVALENT (IIV4) PF IM 0.5 ML | 90686 | $18 |
| Blood Glucose Test | 82947 | $26 – $73 |
| EKG (Electrocardiogram) | 93000 | $36 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $36 – $60 |
| HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE | 86703 | $42 |
| HC TB INTRADERMAL TEST - PPD | 86580 | $45 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $47 – $96 |
| HC PR 99212 OFFICE OUTPATIENT VISIT RHC | 99212 | $55 |
| HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB | 88312 | $57 – $118 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $66 – $129 |
| HC IMMUNIZATION ADMIN CDM | 90471 | $76 |
| Office Visit (Established Patient) | 99213 | $83 |
| HC PR 99202 OFFICE OUTPATIENT NEW RHC | 99202 | $83 |
| HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML | 90750 | $84 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $90 – $171 |
| HC XR CHEST 1 VIEW | 71045 | $93 – $641 |
| Therapeutic Injection | 96372 | $100 |
| Office Visit (Complex) | 99214 | $110 |
| HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | 99385 | $110 |
| Office Visit (New Patient) | 99203 | $110 |
| HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | 99386 | $110 |
| Knee X-Ray | 73560 | $123 – $599 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $134 – $933 |
| HC PR 99396 PREVENTIVE VISIT EST 40-64 RHC | 99396 | $137 |
| HC PR 99215 OFFICE OUTPATIENT VISIT RHC | 99215 | $137 |
| HC PR 99395 PREVENTIVE VISIT EST 18-39 RHC | 99395 | $137 |
| Chest X-Ray (2 Views) | 71046 | $141 – $729 |
| Office Visit (New, Complex) | 99204 | $151 |
| HC PR 99205 OFFICE OUTPATIENT NEW RHC | 99205 | $165 |
| HC PR 90832 PSYTX W PT 30 MIN RHC | 90832 | $169 |
| HC PR 90791 PSYCH DIAG EVAL RHC | 90791 | $169 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $186 |
| HC PR 17111 DESTRUCTION BENIGN LESIONS 15/> RHC | 17111 | $210 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB | 88331 | $225 – $327 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $242 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $242 |
| HC ED REMOVAL OF SKIN TAGS CDM | 11200 | $242 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $242 |
| HC PR 90834 PSYTX W PT 45 MIN RHC | 90834 | $253 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $278 |
| HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS RHC | 12001 | $292 |
| HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE RHC | 10060 | $292 |
| HC PR 11300 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/OR LESS RHC | 11300 | $292 |
| HC PR 11301 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM RHC | 11301 | $292 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $326 – $470 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $338 |
| Psychotherapy (60 min) | 90837 | $338 |
| HC ED FAC E&M VISIT LEVEL 1 CDM | 99281 | $350 |
| Mammogram (Screening) | 77067 | $368 – $394 |
| HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US RHC | 20610 | $425 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $440 – $452 |
| HC ED SEXUAL ASSAULT EXAM CDM | 99284 | $631 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $868 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM | 11400 | $868 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $868 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $901 |
| HC ED FAC E&M VISIT LEVEL 2 CDM | 99282 | $944 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $991 |
| Head CT Scan | 70450 | $1,148 – $1,879 |
| Upper Endoscopy with Biopsy | 43239 | $1,263 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $1,263 |
| Colonoscopy | 45378 | $1,272 |
| Echocardiogram | 93306 | $1,508 |
| HC ED FAC E&M VISIT LEVEL 3 CDM | 99283 | $1,764 |
| HC POLYSOMNOGRAM REDUCED SERVICE | 95810 | $1,779 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $1,857 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $1,919 |
| Lumbar Spine MRI | 72148 | $2,192 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $3,805 |
| Brain MRI with Contrast | 70553 | $3,894 |
| HC ED FAC E&M VISIT LEVEL 5 CDM | 99285 | $4,646 |