| PR TB INTRADERMAL TEST | 86580 | $12 |
| PR BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN | 82270 | $20 |
| PR REFRACTION | 92015 | $28 |
| PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE | 90686 | $32 |
| Knee X-Ray | 73560 | $34 |
| PR CHG X-RAY SHOULDER 2+ VW | 73030 | $36 |
| HB PR-EST PT LEVEL 1 | 99211 | $38 |
| Therapeutic Injection | 96372 | $38 |
| HB CHOLESTEROL TOTAL | 82465 | $39 |
| DEXA Bone Density Scan | 77080 | $42 |
| PR DEXA,BONE DENSITY,APPENDICULR SKELTN | 77081 | $42 |
| HB PR-ADMN IMMUNIZATION INJECT-INITIAL | 90471 | $42 |
| PR RADIOLOGIC EXAM CHEST SINGLE VIEW | 71045 | $50 |
| HB PR-ED VISIT PROB FOC | 99281 | $50 |
| PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX | 90460 | $53 |
| HB SURGICAL PATH LEVEL I | 88300 | $53 |
| HB PR-CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA | 92134 | $65 |
| HB PR-EST PT LEVEL 2 | 99212 | $71 |
| HB URINALYSIS AUTO W/MICRO | 81001 | $75 |
| HB PR-SHAV SKIN LES <5MM REMAINDR BODY | 11305 | $77 |
| Chest X-Ray (2 Views) | 71046 | $77 |
| Complete Blood Count (CBC) | 85025 | $80 |
| PR IV INFUSION, HYDRATION, 31-60 MIN | 96360 | $82 |
| HB PR-EXPD PROB FOC ED E&M | 99282 | $92 |
| PR CORNEAL TOPOGRAPHY | 92025 | $92 |
| Office Visit (Established Patient) | 99213 | $100 |
| Hemoglobin A1c | 83036 | $103 |
| HB PR-DESTRUC BENIGN/PREMAL,FIRST LESION | 17000 | $109 |
| HB PR-SHAV SKIN LES <5MM TRUNK,ARM,LEG | 11300 | $113 |
| HB N. GONORRHOEAE SENDOUT | 87591 | $119 |
| HB HIV-1/2 | 86703 | $120 |
| HB PR-NEW PT LEVEL 2 | 99202 | $124 |
| HB PR-REMOVAL SKIN TAGS 15 LESIONS | 11200 | $125 |
| Head CT Scan | 70450 | $128 |
| Comprehensive Metabolic Panel | 80053 | $131 |
| TSH Thyroid Test | 84443 | $131 |
| HB C. TRACHOMATIS SENDOUT | 87491 | $132 |
| Blood Glucose Test | 82947 | $134 |
| HB PR-ED VISIT LOW COMP | 99283 | $139 |
| Mammogram (Screening) | 77067 | $142 |
| HB PR-SHAV SKIN LES 6-10MM TRUNK,ARM,LEG | 11301 | $143 |
| HB PR-PSYCHOTHERAPY 30 (16-37) MINUTES W/PATIENT | 90832 | $143 |
| HB SPCL STAIN-GROUP 1 MICROORGNSM EA | 88312 | $149 |
| HB PR RADIANT-ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | 20610 | $153 |
| Office Visit (Complex) | 99214 | $157 |
| PR PROSTATE SPECIFIC ANTIGEN,TOTAL | 84153 | $161 |
| HB PR-I/D ABCESS, SIMPLE | 10060 | $165 |
| Lipid Panel | 80061 | $165 |
| PR EYE EXAM, NEW PATIENT,INTERMED | 92002 | $168 |
| Knee MRI | 73721 | $179 |
| HB PR-PREVENTIVE VISIT,EST,18-39 | 99395 | $185 |
| HB PR-PSYCHOTHERAPY 45 (38-52) MINUTES W/PATIENT | 90834 | $188 |
| Cervical Spine MRI | 72141 | $195 |
| Lumbar Spine MRI | 72148 | $195 |
| HB PR-PREVENTIVE VISIT,NEW,18-39 | 99385 | $203 |
| HB PR-PREVENTIVE VISIT,EST,40-64 | 99396 | $203 |
| HB PR-EXC SKIN BENIG <5MM TRUNK,ARM,LEG | 11400 | $206 |
| PR VISUAL FIELD EXAM,EXTENDED | 92083 | $213 |
| HB HZV VACC RECOMBINANT IM NJX -90750 | 90750 | $215 |
| HB PR-EST PT LEVEL 5 | 99215 | $218 |
| Office Visit (New Patient) | 99203 | $221 |
| HB PR-EYE EXAM ESTABLISHED PT | 92012 | $222 |
| EKG (Electrocardiogram) | 93000 | $227 |
| HB PR-EXC SKIN BENIG 0.6-1CM TRUNK,ARM,LEG | 11401 | $235 |
| HB PR-PREVENTIVE VISIT,NEW,40-64 | 99386 | $235 |
| HB PR-EXC SKIN BENIG <5MM FACE,FACIAL | 11440 | $239 |
| HB PR-DESTRUCT B9 LESIONS UP TO 14 LESIONS | 17110 | $241 |
| PR INCISION EARDRUM,ASPIR | 69420 | $247 |
| HB PR-ED VISIT MOD COMP | 99284 | $260 |
| HB PR-BIOPSY OF BREAST, NEEDLE CORE | 19100 | $261 |
| HB PR-LAC REP S N A G T E <2.5CM | 12001 | $269 |
| Psychotherapy (60 min) | 90837 | $278 |
| PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | 95810 | $278 |
| HB PR-DESTRUC FLAT WARTS, 15 OR MORE | 17111 | $287 |
| Office Visit (New, Complex) | 99204 | $287 |
| Brain MRI with Contrast | 70553 | $300 |
| HB SURGICAL PATH LEVEL II | 88302 | $303 |
| HB PR-EYE EXAM, EST PATIENT,COMPREHESV | 92014 | $320 |
| HB PR-PSYTX DIAGNOSTIC EVALUATION | 90791 | $322 |
| HB PR-EXCIS CHALAZION,SINGLE | 67800 | $336 |
| HB PR-NEW PT LEVEL 5 | 99205 | $344 |
| HB SURGICAL PATH LEVEL III | 88304 | $353 |
| HB PR-EYE EXAM, NEW PATIENT,COMPREHESV | 92004 | $385 |
| HB SURGICAL PATH LEVEL IV | 88305 | $401 |
| HB SURGICAL PATH LEVEL V | 88307 | $543 |
| Upper Endoscopy with Biopsy | 43239 | $546 |
| HB PR-ED VISIT HIGH COMP | 99285 | $601 |
| HB PR-TRABECULOPLASTY BY LASER SURGERY | 65855 | $783 |
| PR REMOVE TONSILS/ADENOIDS,12+ Y/O | 42821 | $883 |
| PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | 43235 | $889 |
| PR APPENDECTOMY | 44950 | $1,098 |
| PR MASTECTOMY, PARTIAL | 19301 | $1,112 |
| Colonoscopy | 45378 | $1,266 |
| PR TOTAL ABDOM HYSTERECTOMY | 58150 | $1,286 |
| PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG | 29881 | $1,348 |
| Colonoscopy with Biopsy | 45380 | $1,389 |
| PR CLOSED RX INTER/SUBTROCH FEMUR FX | 27238 | $1,439 |
| PR LAP,APPENDECTOMY | 44970 | $1,515 |
| HB PR-MASTECTOMY, SIMPLE, COMPLETE | 19303 | $1,556 |
| PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | 45385 | $1,573 |
| Laparoscopic Cholecystectomy | 47562 | $1,711 |
| PR APPENDECTOMY,RUPT APPENDX+ABSCESS | 44960 | $1,772 |
| Epidural Steroid Injection | 64483 | $1,838 |
| PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/< | 58260 | $1,979 |
| PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH | 58552 | $2,096 |
| PR KNEE SCOPE,AID ANT CRUCIATE REPAIR | 29888 | $2,102 |
| Echocardiogram | 93306 | $2,147 |
| HB PR-MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY | 19302 | $2,267 |
| HB PR-MASTECTOMY, MODIFIED RADICAL | 19307 | $2,282 |
| PR FEMORAL FX, OPEN TX | 27236 | $2,519 |
| Shoulder Arthroscopy | 29827 | $2,974 |
| Total Hip Replacement | 27130 | $3,056 |
| Total Knee Replacement | 27447 | $3,451 |
| PR REVISE KNEE JOINT REPLACE,1 PART | 27486 | $4,438 |