| HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | 82270 | $14 |
| HC ADMIN HEPATITIS B VACCINE CDM | 90471 | $17 |
| HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | 81001 | $29 |
| HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | 87591 | $29 |
| HC PR 99211 ESTAB PT VISIT - LEVEL 1 | 99211 | $38 |
| Blood Glucose Test | 82947 | $39 |
| HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM | 99281 | $40 |
| Hemoglobin A1c | 83036 | $41 |
| Complete Blood Count (CBC) | 85025 | $42 |
| HC CHOLESTEROL | 82465 | $45 |
| Therapeutic Injection | 96372 | $48 |
| HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | 11400 | $58 |
| Comprehensive Metabolic Panel | 80053 | $60 |
| Lipid Panel | 80061 | $67 |
| HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | 84153 | $70 |
| TSH Thyroid Test | 84443 | $74 |
| HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | 87491 | $78 |
| HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM | 99282 | $80 |
| HC PR 99212 ESTAB PT VISIT - LEVEL 2 | 99212 | $82 |
| HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB | 88300 | $97 |
| HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | 90832 | $98 |
| HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | 87624 | $117 |
| HC PR ED 99283 VISIT LOW MDM CDM | 99283 | $119 |
| HC HIV-1/HIV-2 SINGLE ASSAY | 86703 | $122 |
| HC BONE DENSITY PERIPHERAL SKELETON | 77081 | $136 |
| HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | 90834 | $138 |
| HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88302 | $138 |
| HC ED DESTRUCT PREMALG LESION FIRST LESION CDM | 17000 | $139 |
| Office Visit (New Patient) | 99203 | $148 |
| Office Visit (Established Patient) | 99213 | $155 |
| HC ED EYE EXAM NEW PATIENT CDM | 92002 | $166 |
| HC BILL SURG SPECIAL STAINS GROUP 1 | 88312 | $171 |
| Knee X-Ray | 73560 | $182 |
| HC XR SHOULDER COMPLETE MIN 2 VIEWS | 73030 | $182 |
| Psychotherapy (60 min) | 90837 | $184 |
| HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $192 |
| HC PR 99202 NEW PT VISIT - LEVEL 2 | 99202 | $198 |
| HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM | 12001 | $209 |
| HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | 10060 | $223 |
| HC PR ED 99284 VISIT MODERATE MDM CDM | 99284 | $227 |
| Chest X-Ray (2 Views) | 71046 | $230 |
| HC XR CHEST 1 VIEW | 71045 | $230 |
| HC IV HYDRATION INITIAL HR CDM | 96360 | $236 |
| Mammogram (Screening) | 77067 | $238 |
| Office Visit (Complex) | 99214 | $244 |
| HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM | 11305 | $250 |
| HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM | 17110 | $250 |
| Office Visit (New, Complex) | 99204 | $270 |
| HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM | 69420 | $287 |
| HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88305 | $289 |
| HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88304 | $289 |
| HC PR 99205 NEW PT VISIT - LEVEL 5 | 99205 | $306 |
| HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC | 88331 | $307 |
| HC PR 99215 ESTAB PT VISIT - LEVEL 5 | 99215 | $311 |
| HC PR ED 99285 VISIT HIGH MDM CDM | 99285 | $333 |
| HC REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | 11200 | $342 |
| DEXA Bone Density Scan | 77080 | $344 |
| HC ED EXCISION CHALAZION SINGLE CDM | 67800 | $366 |
| HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | 20610 | $414 |
| HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM | 11401 | $515 |
| HC SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/OR LESS | 11300 | $540 |
| HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88307 | $614 |
| HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | 88309 | $626 |
| Cervical Spine MRI | 72141 | $747 |
| HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM | 11440 | $895 |
| HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM | 43235 | $990 |
| Upper Endoscopy with Biopsy | 43239 | $990 |
| Colonoscopy | 45378 | $998 |
| Head CT Scan | 70450 | $999 |
| Knee MRI | 73721 | $1,154 |
| Echocardiogram | 93306 | $1,156 |
| Lumbar Spine MRI | 72148 | $1,331 |
| HC POLYSOMNOGRAPHY 4 OR MORE | 95810 | $1,886 |
| HC ED ABLATE INF TURBINATE SUPERFICIAL CDM | 30801 | $1,915 |
| HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM | 27238 | $1,980 |
| Epidural Steroid Injection | 64483 | $2,134 |
| Brain MRI with Contrast | 70553 | $2,697 |
| HC ED REPAIR OF NASAL SEPTUM CDM | 30520 | $3,926 |