| HC 99281 PRO ED VISIT LEVEL I | 99281 | $17 |
| HC CA SCREEN, OCCULT BLOOD, 1-3 DETERM | 82270 | $24 – $30 |
| HC 99211 PRO TCS VISIT EST PT LEVEL I | 99211 | $34 |
| TSH Thyroid Test | 84443 | $34 – $125 |
| HC 99282 PRO ED VISIT LEVEL II | 99282 | $34 |
| HC SKIN TEST - TUBERCULOSIS, INTRADERMAL | 86580 | $46 |
| HC URINALYSIS, AUTO W/SCOPE | 81001 | $50 – $89 |
| HC CHOLESTEROL, SERUM, TOTAL | 82465 | $51 – $88 |
| Blood Glucose Test | 82947 | $51 – $79 |
| HC SO GONORRHOEAE AMP PROBE, CGRNA | 87591 | $53 |
| HC SO CHLAMYDIA AMP PROBE, CGRNA | 87491 | $53 |
| HC 99283 PRO ED VISIT LEVEL III | 99283 | $55 |
| HC 99212 PRO TCS VISIT EST PT LEVEL II | 99212 | $59 |
| HC 90471 IMMUNIZATION ADMIN, ONE VACCINE | 90471 | $70 |
| Complete Blood Count (CBC) | 85025 | $80 – $118 |
| Hemoglobin A1c | 83036 | $82 |
| Office Visit (Established Patient) | 99213 | $83 |
| HC 99284 PRO ED VISIT LEVEL IV | 99284 | $100 |
| HC 90832 PRO PSYCHOTHERAPY 30 MIN W/PT | 90832 | $109 |
| HC 17110 PRO DESTRUCTION OF BENIGN LESIONS; UP TO 14 LESIONS | 17110 | $116 |
| HC SURG PATH LEVEL I, GROSS ONLY | 88300 | $129 – $137 |
| HC OP VISIT, NEW PT, LEVEL IIB | 99202 | $133 |
| Lipid Panel | 80061 | $140 – $163 |
| HC LAB PSA TOTAL | 84153 | $142 – $243 |
| Office Visit (Complex) | 99214 | $143 |
| HC 99285 PRO ED VISIT LEVEL V | 99285 | $146 |
| HC 90834 PRO PSYCHOTHERAPY 45 MIN PT-EAP | 90834 | $147 |
| Office Visit (New Patient) | 99203 | $158 |
| HC 10060 PRO INCISION & DRAINAGE OF ABSCESS; SIMPLE OR SINGLE | 10060 | $166 |
| HC PRO ARTHRO,ASP/INJ MAJOR JOINT/BURSA; WO GUIDE-RT | 20610 | $168 |
| HC SFMC FUNG SILVER STAIN LAB TEST | 88312 | $172 – $212 |
| HC OP VISIT, ESTAB PT, COMPLEX | 99215 | $182 |
| HC SIM REP,SLP,NCK,AXL,TRK,EXT<=2.5 | 12001 | $187 |
| HC 11200 REMOVAL OF SKIN TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS | 11200 | $189 |
| Comprehensive Metabolic Panel | 80053 | $193 – $297 |
| HC 71045 CHEST SINGLE VIEW (EH) | 71045 | $203 |
| Office Visit (New, Complex) | 99204 | $214 |
| Psychotherapy (60 min) | 90837 | $219 |
| HC DEST WART BENIGN LESION 1ST | 17000 | $239 |
| HC 17111 DESTRUCTION, OF BENIGN LESIONS; 15 OR MORE LESIONS | 17111 | $269 |
| HC 90791 PRO PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $269 |
| HC OP VISIT, NEW PT, LEVEL VB | 99205 | $273 |
| HC 96360 IV INF,HYDR;INIT 31 MIN TO 1 HOUR | 96360 | $281 |
| HC LEVEL II SURG PATH GROSS & MICRO | 88302 | $296 – $314 |
| Mammogram (Screening) | 77067 | $325 |
| Chest X-Ray (2 Views) | 71046 | $329 |
| HC FROZEN SECTION | 88331 | $370 – $393 |
| Knee X-Ray | 73560 | $376 |
| HC LEVEL III SURG PATH GROSS & MICRO ONLY | 88304 | $378 – $401 |
| Therapeutic Injection | 96372 | $406 |
| HC 73030 SHOULDER COMPLETE, MIN 2V-LT | 73030 | $411 |
| HC 11401 EXCISION BENIGN LESION INC MARGINS, EXC SKIN TAG, TRK/ARM/LEG .6 - 1CM | 11401 | $444 |
| HC LEVEL IV SURG PATH GROSS & MICRO | 88305 | $463 – $491 |
| HC 77081 BC-DEXA,1 OR MORE SITES,APNDIC SKELETON | 77081 | $484 |
| HC LEVEL V SURG PATH GROSS & MICRO ONLY | 88307 | $497 – $526 |
| HC 11440 EXCISION BENIGN LESION INC MARGIN, EXC SKIN TAG, F/E/E/N/L/M; 0.5CM/< | 11440 | $547 |
| DEXA Bone Density Scan | 77080 | $576 |
| HC CLSD TX FEMORAL FX WITHOUT MANIP-LT | 27238 | $719 |
| HC CONSULT & RPT ON REF MATER W SLIDES | 88323 | $941 – $999 |
| HC 43235 EGD, TRANSORAL DIAG W/SPEC COLL | 43235 | $1,125 |
| HC LEVEL VI SURG PATH GROSS & MICRO ONLY | 88309 | $1,139 – $1,145 |
| HC ARTHRO KNEE SURG W/MENISCECTOMY MED OR LAT-RT | 29881 | $1,217 |
| Upper Endoscopy with Biopsy | 43239 | $1,250 |
| Epidural Steroid Injection | 64483 | $1,868 |
| Head CT Scan | 70450 | $1,881 |
| HC OPEN TX FEM FX PROX/NECK INT FIX OR PROS-RT | 27236 | $2,623 |
| Echocardiogram | 93306 | $2,660 |
| Lumbar Spine MRI | 72148 | $3,092 |
| Knee MRI | 73721 | $3,094 |
| Total Hip Replacement | 27130 | $3,140 |
| Total Knee Replacement | 27447 | $3,146 |
| HC 27486 PRO REVISION TOTAL KNEE ARTHROPLASTY, W OR W/O ALLOGRAFT; 1 COMP - RT | 27486 | $3,152 |
| Cervical Spine MRI | 72141 | $3,189 |
| Brain MRI with Contrast | 70553 | $3,772 |
| HC 27487 PRO REVISE TOTAL KNEE ARTHROPLASTY; FEM & /OR TIBIAL COMPONENT | 27487 | $4,227 |
| HC 95808 POLYSOMNOGRAPHY, 1-3 ADDL PARAM | 95808 | $4,292 |
| HC 95810 POLYSOMNOGRAPH, 4 OR > PARAM-REDUC | 95810 | $5,085 |