| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $2 | $2 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $8 | $8 | $8 |
| Lipid panel CPT 80061 • Laboratory | $5 | $5 | $5 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $6 | $6 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $3 | $3 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $1 | $1 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $13 | $13 | $13 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $24 | $24 | $24 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $5 | $5 | $5 |
| Ferritin CPT 82728 • Laboratory | $10 | $10 | $11 |
| Hemoglobin A1c CPT 83036 • Laboratory | $7 | $7 | $7 |
| Iron binding capacity CPT 83550 • Laboratory | $7 | $7 | $7 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $7 | $7 | $7 |
| Complete blood count with differential CPT 85025 • Laboratory | $6 | $6 | $6 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $1 | $1 | $1 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $10 | $10 | $10 |
| TB skin test intradermal CPT 86580 • Laboratory | $8 | $8 | $8 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $28 | $28 | $28 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $7 | $10 | $13 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $195 | $195 | $195 |
| Fetal non-stress test CPT 59025 • Maternity | $18 | $32 | $46 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,035 | $1,035 | $1,036 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,272 | $1,272 | $1,272 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,441 | $2,441 | $2,441 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $72 | $72 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $71 | $71 | $71 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $32 | $57 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $181 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $191 | $191 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $92 | $92 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $102 | $102 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $129 | $129 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $138 | $161 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $144 | $144 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $176 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $83 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $112 | $131 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $150 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $77 | $77 | $77 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $132 | $132 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $22 | $22 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $70 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $109 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $119 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $215 | $215 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $30 | $30 |