| Glucose quantitative blood CPT 82947 • Laboratory | $5 | $5 | $5 |
| Hemoglobin A1c CPT 83036 • Laboratory | $13 | $13 | $13 |
| Iron serum CPT 83540 • Laboratory | $9 | $9 | $9 |
| Iron binding capacity CPT 83550 • Laboratory | $12 | $12 | $12 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $18 | $18 | $18 |
| Free thyroxine (T4) CPT 84439 • Laboratory | $12 | $12 | $12 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $23 | $23 | $23 |
| Complete blood count with differential CPT 85025 • Laboratory | $7 | $9 | $11 |
| Complete blood count automated CPT 85027 • Laboratory | $9 | $9 | $9 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $5 | $5 | $5 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $4 | $4 | $4 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $6 | $7 | $8 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $12 | $12 | $12 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $17 | $21 | $25 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $7 | $7 | $7 |
| TB skin test intradermal CPT 86580 • Laboratory | $10 | $10 | $10 |
| Blood typing ABO CPT 86900 • Laboratory | $3 | $3 | $3 |
| Blood typing Rh CPT 86901 • Laboratory | $3 | $3 | $3 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $11 | $11 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $34 | $34 | $34 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $34 | $34 | $34 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $56 | $62 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $16 | $16 | $16 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $16 | $16 | $16 |
| Fetal non-stress test CPT 59025 • Maternity | $22 | $39 | $56 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $36 | $36 | $36 |
| Vaginal delivery only CPT 59409 • Maternity | $36 | $488 | $941 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,196 | $1,196 | $1,196 |
| Postpartum care only CPT 59430 • Maternity | $311 | $311 | $311 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $3,094 | $3,094 | $3,094 |
| Cesarean delivery only CPT 59514 • Maternity | $1,062 | $1,062 | $1,062 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $125 | $125 | $125 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $143 | $143 | $143 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $36 | $36 | $36 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $99 | $99 | $99 |
| Interactive complexity add-on CPT 90785 • Mental Health | $7 | $7 | $7 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $195 | $212 | $229 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $229 | $229 | $229 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $123 | $123 | $123 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $118 | $128 | $139 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $174 | $174 | $174 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $65 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $131 | $131 | $131 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $36 | $36 | $36 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $194 | $226 | $259 |
| Office visit established patient minimal CPT 99211 • Office Visits | $36 | $36 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $36 | $52 | $69 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $36 | $36 | $36 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $36 | $36 | $36 |