| HC FLUZONE QUAD PFS 0.5ML INJ | 90686 | $12 |
| HC IMM ADM ONE VAC SGL/COMB | 90471 | $12 |
| HC BLOOD OCCULT FECES W SINGLE DETERMINATION | 82270 | $20 |
| HC CHOLESTEROL TOTAL | 82465 | $31 |
| HC LEVEL 1 GROSS EXAM | 88300 | $44 |
| Complete Blood Count (CBC) | 85025 | $52 |
| HC TB INTRADERMAL TEST | 86580 | $57 |
| Blood Glucose Test | 82947 | $66 |
| HC CONSULT & REPORT REF MATERIAL | 88323 | $68 |
| CHLMYD TRACH DNA AMP PRB P5112 | 87491 | $71 |
| N GONORR DNA AMP PROB P5112 | 87591 | $71 |
| Hemoglobin A1c | 83036 | $75 |
| HC URINE ROUTINE MICRO | 81001 | $76 |
| HC PSYCHOTHERAPY 30 MINUTES | 90832 | $89 |
| HC HIV1/HIV2 1 RSLT ANTBDY | 86703 | $97 |
| HC LEVEL 2 GROSS & MICRO EXAM | 88302 | $109 |
| Therapeutic Injection | 96372 | $112 |
| HC LIFESTYLE PVT MINIMUM 15 MIN | 99211 | $112 |
| TSH Thyroid Test | 84443 | $118 |
| HC DEXA APPEND SKEL PERIPHERAL | 77081 | $121 |
| HC PROSTATIC SPECIFIC ANTIGEN TOTAL | 84153 | $130 |
| HC SPECIAL STAIN GROUP 1 | 88312 | $131 |
| HC CLINIC VISIT EST 99212 | 99212 | $137 |
| HC PATH CONSULT INTRAOP 1 BLOCK | 88331 | $141 |
| SHINGRIX VACCINE INJ | 90750 | $150 |
| HC PSYCH DIAGNOSTIC EVAL | 90791 | $160 |
| HC IMM ADMIN 1ST/ONLY COMPONENT | 90460 | $170 |
| Office Visit (Established Patient) | 99213 | $184 |
| Office Visit (Complex) | 99214 | $194 |
| HC CPTRZ OPH DX IMG PST SGM RETNA | 92134 | $200 |
| Lipid Panel | 80061 | $203 |
| HC LEVEL 3 GROSS & MICRO EXAM | 88304 | $212 |
| HC INFECT AGNT DET HPV HIGH-RISK TYPES | 87624 | $215 |
| HC ACUITY LEVEL 1 | 99281 | $224 |
| HC CLINIC VISIT EST 99215 | 99215 | $227 |
| HC CLINIC VISIT NEW 99202 W/PROC | 99202 | $254 |
| Mammogram (Screening) | 77067 | $263 |
| DEXA Bone Density Scan | 77080 | $279 |
| HC LEVEL 4 GROSS & MICRO EXAM | 88305 | $308 |
| Office Visit (New Patient) | 99203 | $325 |
| HC ACUITY LEVEL 2 | 99282 | $354 |
| Office Visit (New, Complex) | 99204 | $379 |
| HC SMPL LAC RPR 0-2.5CM SCALP | 12001 | $388 |
| HC ARTHRO ASP INJ MJR J/BU WO US | 20610 | $403 |
| HC DESTR BENIGN LESIONS 1-14 | 17110 | $403 |
| HC CLINIC VISIT NEW 99205 W/PROC | 99205 | $457 |
| Chest X-Ray (2 Views) | 71046 | $470 |
| Knee X-Ray | 73560 | $470 |
| HC SHOULDER MIN 2 VIEWS | 73030 | $470 |
| HC CHEST 1 VIEW | 71045 | $470 |
| HC IV INF HYDRATION 1ST HR | 96360 | $506 |
| HC ACUITY LEVEL 3 | 99283 | $510 |
| HC DESTRUCT LESION 15 OR MORE | 17111 | $551 |
| HC EST 1ST TRI BASIC PKG 18-39 | 99395 | $590 |
| HC EST 1ST TRI BASIC PKG 40-64 | 99396 | $590 |
| HC NEW 1ST TRI BASIC PKG 18-39 | 99385 | $590 |
| HC NEW 1ST TRI BASIC PKG 40-64 | 99386 | $590 |
| HC DEST PRE-MALIGNANT LES 1ST | 17000 | $615 |
| HC SHAV EPI/DER LES SCLP <0.5CM | 11305 | $637 |
| HC SHAV EPI/DER LES TRK 0.6-1.0CM | 11301 | $637 |
| HC SHAV EPI/DERM LES TRNK<0.5CM | 11300 | $637 |
| HC REMOVAL OF SKIN TAGS UP TO 15 | 11200 | $666 |
| HC BIOPSY SKIN 1 LESION | 11100 | $733 |
| HC LEVEL 5 GROSS & MICRO EXAM | 88307 | $800 |
| HC ID SIMPLE ABSCESS | 10060 | $881 |
| HC LEVEL 6 GROSS & MICRO EXAM | 88309 | $1,030 |
| Comprehensive Metabolic Panel | 80053 | $1,040 |
| HC ACUITY LEVEL 4 | 99284 | $1,223 |
| Colonoscopy | 45378 | $1,500 |
| HC ACUITY LEVEL 5 | 99285 | $1,615 |
| HC BX BREAST PERC NDL CRE WO/IMAG | 19100 | $1,670 |
| Echocardiogram | 93306 | $1,866 |
| HC EXC TR-EXT B9+MARG 0.5 CM< | 11400 | $1,930 |
| Head CT Scan | 70450 | $2,020 |
| HC EXCISION LES B T A L 0.6-1.0CM | 11401 | $2,281 |
| Epidural Steroid Injection | 64483 | $3,193 |
| HC EGD W/WO BRUSHINGS | 43235 | $3,288 |
| HC NAS/SINUS ENDO W BX/POLYP/DEBR | 31237 | $3,452 |
| Upper Endoscopy with Biopsy | 43239 | $3,973 |
| Cervical Spine MRI | 72141 | $4,272 |
| Knee MRI | 73721 | $4,272 |
| Lumbar Spine MRI | 72148 | $4,272 |
| Colonoscopy with Biopsy | 45380 | $4,815 |
| HC COLONOSCOPY W/SNARE TECHNIQUE | 45385 | $5,583 |
| Brain MRI with Contrast | 70553 | $6,741 |
| HC PSG 9+PARAM ATTENDED | 95810 | $8,374 |