| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $79 | $79 | $79 |
| Auto-added CPT 81025 • General | $7 | $7 | $7 |
| Auto-added CPT 87811 • General | $41 | $41 | $41 |
| Strep test rapid (Streptococcus group A direct) CPT 87880 • Lab | $13 | $13 | $13 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $185 | $185 | $185 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $108 | $108 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $30 | $30 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $30 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $30 | $30 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $30 | $30 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $30 | $30 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $30 | $30 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $127 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $115 | $115 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $86 | $86 | $86 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $94 | $94 | $94 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $132 | $132 |