| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $14 | $14 | $15 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $28 | $28 | $28 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $6 | $6 | $6 |
| Ferritin CPT 82728 • Laboratory | $13 | $13 | $13 |
| Iron binding capacity CPT 83550 • Laboratory | $8 | $8 | $8 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $17 | $17 | $17 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $6 | $6 | $6 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $12 | $12 | $12 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $16 | $16 | $16 |
| TB skin test intradermal CPT 86580 • Laboratory | $4 | $4 | $4 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $27 | $27 | $27 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $27 | $27 | $27 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $11 | $11 | $11 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $179 | $179 | $179 |
| Chorionic villus sampling CPT 59015 • Maternity | $40 | $40 | $40 |
| Fetal non-stress test CPT 59025 • Maternity | $26 | $32 | $39 |
| Insertion cervical dilator CPT 59200 • Maternity | $39 | $39 | $39 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,100 | $2,100 | $2,100 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $788 | $788 | $788 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $40 | $40 | $40 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,100 | $2,100 | $2,100 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $60 | $60 | $60 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $54 | $54 | $54 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $24 | $27 | $31 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $4 | $4 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $93 | $109 | $124 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $124 | $124 | $124 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $70 | $70 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $70 | $70 | $70 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $78 | $78 | $78 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $68 | $68 | $68 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $89 | $89 | $89 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $105 | $105 | $105 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $124 | $124 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $46 | $46 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $91 | $91 | $91 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $91 | $91 |
| Group psychotherapy CPT 90853 • Mental Health | $48 | $48 | $48 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $140 | $140 | $140 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $68 | $68 | $68 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $99 | $99 | $99 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $98 | $98 | $98 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $65 | $65 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $127 | $146 | $165 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $160 | $182 | $204 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $104 | $104 | $104 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $146 | $146 | $146 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $90 | $90 |
| Consultation office low complexity CPT 99243 • Office Visits | $105 | $115 | $124 |