| Nuclear myocardial perfusion study CPT 78452 • Imaging | $387 | $387 | $387 |
| Venipuncture (routine blood draw) CPT 36415 • Lab | $5 | $5 | $5 |
| Urinalysis non-automated without microscopy CPT 81002 • Lab | $5 | $5 | $5 |
| Strep test rapid (Streptococcus group A direct) CPT 87880 • Lab | $13 | $13 | $13 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $17 | $17 | $17 |
| Lipid panel CPT 80061 • Laboratory | $13 | $13 | $13 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $4 | $4 | $4 |
| Ferritin CPT 82728 • Laboratory | $26 | $26 | $26 |
| Glucose quantitative blood CPT 82947 • Laboratory | $6 | $6 | $6 |
| Hemoglobin A1c CPT 83036 • Laboratory | $5 | $5 | $5 |
| Iron serum CPT 83540 • Laboratory | $12 | $12 | $12 |
| Iron binding capacity CPT 83550 • Laboratory | $17 | $17 | $17 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $20 | $20 | $20 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $27 | $27 | $27 |
| Complete blood count with differential CPT 85025 • Laboratory | $14 | $14 | $14 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $7 | $7 | $7 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $13 | $13 | $13 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $38 | $38 | $38 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $38 | $38 | $38 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $75 | $75 | $75 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $20 | $20 | $20 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $53 | $53 | $53 |
| Insertion cervical dilator CPT 59200 • Maternity | $29 | $29 | $29 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $4,187 | $4,187 | $4,187 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,510 | $1,510 | $1,510 |
| Postpartum care only CPT 59430 • Maternity | $383 | $383 | $383 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $56 | $56 | $56 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $36 | $36 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $240 | $240 | $240 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $119 | $119 | $119 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $158 | $158 | $158 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $190 | $190 | $190 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $61 | $61 | $61 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $40 | $40 | $40 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $96 | $96 | $96 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $148 | $148 | $148 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $260 | $260 | $260 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $329 | $329 | $329 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $105 | $105 | $105 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $120 | $120 | $120 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $171 | $171 | $171 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $344 | $344 | $344 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $865 | $865 | $865 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $26 | $26 | $26 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $131 | $131 | $131 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $940 | $940 | $940 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $139 | $139 | $139 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $964 | $964 | $964 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $964 | $964 | $964 |