| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $9 | $9 | $10 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $18 | $18 | $18 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $4 | $4 | $4 |
| Ferritin CPT 82728 • Laboratory | $8 | $8 | $8 |
| Iron binding capacity CPT 83550 • Laboratory | $5 | $5 | $5 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $11 | $11 | $11 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $4 | $4 | $4 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $7 | $7 | $7 |
| TB skin test intradermal CPT 86580 • Laboratory | $7 | $7 | $7 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $21 | $21 | $21 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $9 | $9 | $10 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $197 | $197 | $197 |
| Chorionic villus sampling CPT 59015 • Maternity | $156 | $156 | $156 |
| Fetal non-stress test CPT 59025 • Maternity | $25 | $25 | $25 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,054 | $1,054 | $1,054 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,760 | $1,760 | $1,760 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $104 | $104 | $104 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $113 | $113 | $113 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $33 | $33 | $33 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $23 | $42 | $61 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $4 | $4 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $155 | $200 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $151 | $152 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $82 | $82 | $82 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $106 | $106 | $106 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $90 | $106 | $121 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $101 | $110 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $196 | $196 | $196 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $185 | $185 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $163 | $163 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $76 | $79 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $94 | $110 | $125 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $157 | $157 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $47 | $47 | $47 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $117 | $117 | $118 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $351 | $351 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $88 | $88 | $88 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $128 | $128 | $128 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $45 | $45 | $45 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $91 | $91 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $129 | $129 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $163 | $196 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $246 | $246 | $246 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $54 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $110 | $110 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $160 | $160 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $173 | $173 | $173 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $217 | $217 | $217 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $116 | $116 | $116 |