| Nuclear antigen antibody CPT 86235 • Laboratory | $12 | $12 | $12 |
| TB skin test intradermal CPT 86580 • Laboratory | $6 | $6 | $6 |
| Blood typing ABO CPT 86900 • Laboratory | $2 | $2 | $2 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $2 | $2 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $23 | $23 | $24 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $26 | $26 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $11 | $11 | $11 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $155 | $155 | $155 |
| Chorionic villus sampling CPT 59015 • Maternity | $101 | $101 | $101 |
| Fetal non-stress test CPT 59025 • Maternity | $22 | $30 | $38 |
| Insertion cervical dilator CPT 59200 • Maternity | $102 | $102 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,950 | $1,950 | $1,950 |
| Vaginal delivery only CPT 59409 • Maternity | $618 | $618 | $618 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $836 | $836 | $836 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,035 | $1,035 | $1,035 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,950 | $1,950 | $1,950 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $93 | $139 | $184 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $84 | $84 | $84 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $36 | $66 | $95 |
| Interactive complexity add-on CPT 90785 • Mental Health | $12 | $12 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $111 | $130 | $149 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $167 | $167 | $167 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $70 | $70 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $64 | $64 | $65 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $81 | $87 | $93 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $70 | $76 | $82 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $102 | $102 | $102 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $109 | $109 | $109 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $132 | $132 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $43 | $54 | $65 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $65 | $77 | $88 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $92 | $92 | $92 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $18 | $18 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $120 | $120 | $120 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $121 | $121 | $121 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $352 | $352 | $352 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $101 | $101 | $101 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $141 | $141 | $141 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $81 | $81 | $81 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $101 | $101 | $101 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $121 | $121 | $121 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $158 | $158 | $158 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $259 | $259 | $259 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $55 | $55 | $55 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $86 | $107 | $128 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $117 | $143 | $169 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $2 | $4 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $43 | $43 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $70 | $70 | $70 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $98 | $98 | $98 |