| Free thyroxine (T4) CPT 84439 • Laboratory | $4 | $5 | $6 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $8 | $11 | $13 |
| Complete blood count with differential CPT 85025 • Laboratory | $3 | $5 | $6 |
| Complete blood count automated CPT 85027 • Laboratory | $3 | $4 | $5 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $2 | $3 | $4 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $2 | $2 | $2 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $4 | $4 | $4 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $9 | $9 | $9 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $13 | $13 | $13 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $5 | $5 | $5 |
| TB skin test intradermal CPT 86580 • Laboratory | $5 | $7 | $8 |
| Blood typing ABO CPT 86900 • Laboratory | $2 | $2 | $2 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $2 | $2 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $6 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $13 | $15 | $17 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $13 | $15 | $17 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $31 | $36 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $6 | $11 | $14 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $7 | $11 | $13 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $116 | $116 | $116 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $184 | $184 | $184 |
| Chorionic villus sampling CPT 59015 • Maternity | $135 | $135 | $135 |
| Fetal non-stress test CPT 59025 • Maternity | $26 | $31 | $35 |
| Insertion cervical dilator CPT 59200 • Maternity | $41 | $41 | $41 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,387 | $1,387 | $1,387 |
| Vaginal delivery only CPT 59409 • Maternity | $697 | $697 | $697 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $778 | $778 | $778 |
| External cephalic version CPT 59412 • Maternity | $92 | $92 | $92 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $562 | $562 | $562 |
| Postpartum care only CPT 59430 • Maternity | $122 | $145 | $168 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,572 | $1,572 | $1,572 |
| Cesarean delivery only CPT 59514 • Maternity | $822 | $822 | $822 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $928 | $928 | $928 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,465 | $1,465 | $1,465 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $45 | $47 | $49 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $98 | $106 | $114 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $210 | $210 | $210 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $24 | $50 | $76 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $34 | $36 | $37 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $95 | $120 | $146 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $122 | $141 | $160 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $56 | $61 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $41 | $52 | $63 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $75 | $77 | $79 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $102 | $105 | $109 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $106 | $106 | $106 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $159 | $159 | $159 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $83 | $83 | $83 |