| Blood Glucose Test | 82947 | $4 |
| HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD | 82270 | $15 |
| Office Visit (New, Complex) | 99204 | $21 |
| Office Visit (New Patient) | 99203 | $23 |
| HC HIV 4TH GEN CONFIRMATION | 86703 | $28 |
| HC OSTOMY F/U VISITS (FOLLOW UP) | 99211 | $34 |
| Office Visit (Established Patient) | 99213 | $42 |
| Office Visit (Complex) | 99214 | $42 |
| HC EST PT OUTPT VISIT LEVEL 2 | 99212 | $42 |
| HC NEW PT OUTPT VISIT LEVEL 2 | 99202 | $45 |
| HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID | 90460 | $45 |
| HC EST PT OUTPT VISIT LEVEL 5 - TMC ONLY | 99215 | $48 |
| Hemoglobin A1c | 83036 | $54 |
| TSH Thyroid Test | 84443 | $54 |
| HC NEW PT OUTPT VISIT LEVEL 5 | 99205 | $54 |
| HC PROSTATE SPECIFIC AG PSA TOTAL | 84153 | $57 |
| HC RL HUMAN PAPILLOMAVIRUS HIGH RISK | 87624 | $65 |
| HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID | 90471 | $75 |
| HC CAPD INPT SKIN TEST - PPD | 86580 | $77 |
| HC LEVEL 1 PATH GROSS ONLY | 88300 | $82 |
| Complete Blood Count (CBC) | 85025 | $101 |
| HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC | 81001 | $121 |
| HC SPECIAL STAINS,GROUP I - BUNDLED CHARGE | 88312 | $137 |
| HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL | 82465 | $139 |
| Mammogram (Screening) | 77067 | $144 |
| Therapeutic Injection | 96372 | $152 |
| HC RL CHLAMYDIA TRACH PCR AMPLIFIED | 87491 | $163 |
| HC RL N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR | 87591 | $187 |
| HC PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | 90832 | $221 |
| HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB | 99281 | $233 |
| HC RL CONSULTATION SLIDE PREP S/O | 88323 | $243 |
| HC LEVEL 2 PATH GROSS & MICRO | 88302 | $249 |
| HC LEVEL 3 PATH GROSS & MICRO | 88304 | $259 |
| HC PATH CONSULT IN SURG,W FRZ SEC - BUNDLED CHARGE | 88331 | $272 |
| HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES | 90834 | $288 |
| Comprehensive Metabolic Panel | 80053 | $288 |
| Knee X-Ray | 73560 | $295 |
| Lipid Panel | 80061 | $306 |
| HC LEVEL 4 PATH GROSS & MICRO | 88305 | $308 |
| Psychotherapy (60 min) | 90837 | $315 |
| HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW | 71045 | $324 |
| HC DESTRUC BENIGN/PREMAL,FIRST LESION | 17000 | $327 |
| HC BIOPSY OF BREAST, NEEDLE CORE | 19100 | $355 |
| HC LEVEL 5 PATH GROSS & MICRO | 88307 | $361 |
| DEXA Bone Density Scan | 77080 | $362 |
| HC PSYCHIATRIC DIAGNOSTIC EVALUATION | 90791 | $387 |
| Chest X-Ray (2 Views) | 71046 | $389 |
| HC IV INFUSION, HYDRATION, 31-60 MIN | 96360 | $412 |
| HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY | 99282 | $413 |
| HC LEVEL 6 PATH GROSS & MICRO | 88309 | $437 |
| HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS | 73030 | $439 |
| HC REMOVAL OF SKIN TAGS, UP TO & INCLUDING 15 LESIONS | 11200 | $508 |
| HC SHAVING OF DERMAL/EPIDERMAL LE | 11300 | $512 |
| HC RESUPERF WND BODY <2.5CM | 12001 | $601 |
| HC DRAIN SKIN ABSCESS SIMPLE | 10060 | $739 |
| HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY | 99283 | $824 |
| Epidural Steroid Injection | 64483 | $886 |
| Head CT Scan | 70450 | $1,027 |
| HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $1,140 |
| HC COMPLEX POLYSOMNOGRAPH-REDUCED | 95810 | $1,328 |
| HC EXC SKIN BENIG <0.5 CM FACE,FACIAL | 11440 | $1,347 |
| HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY | 99284 | $1,362 |
| HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | 43235 | $1,456 |
| Colonoscopy | 45378 | $1,541 |
| Upper Endoscopy with Biopsy | 43239 | $1,541 |
| HC COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ - COLONOSCOPY | 45385 | $1,541 |
| Colonoscopy with Biopsy | 45380 | $1,541 |
| Knee MRI | 73721 | $1,610 |
| HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC | 99285 | $1,763 |
| Echocardiogram | 93306 | $1,776 |
| Lumbar Spine MRI | 72148 | $1,930 |
| HC NASAL/SINUS ENDOSCOPY,BX/RMV POLYP/DEBRID | 31237 | $1,975 |
| Cervical Spine MRI | 72141 | $2,078 |
| HC BIOPSY OF PROSTATE,NEEDLE/PUNCH | 55700 | $2,393 |
| Brain MRI with Contrast | 70553 | $2,417 |
| HC LAPAROSCOPY APPENDECTOMY | 44970 | $9,357 |