| 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 | $2 | $3 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $2 | $2 | $2 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $1 | $1 | $1 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $10 | $10 | $10 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $14 | $14 | $14 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $4 | $4 | $4 |
| TB skin test intradermal CPT 86580 • Laboratory | $4 | $7 | $8 |
| 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 | $21 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $23 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $22 | $36 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $11 | $13 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $3 | $5 | $7 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $99 | $99 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $172 | $172 | $172 |
| Fetal non-stress test CPT 59025 • Maternity | $16 | $29 | $41 |
| Vaginal delivery only CPT 59409 • Maternity | $691 | $691 | $691 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $914 | $914 | $914 |
| External cephalic version CPT 59412 • Maternity | $88 | $88 | $88 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $878 | $878 | $878 |
| Postpartum care only CPT 59430 • Maternity | $168 | $198 | $228 |
| Cesarean delivery only CPT 59514 • Maternity | $781 | $781 | $781 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,155 | $2,155 | $2,155 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $49 | $73 | $97 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $98 | $105 | $112 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $76 | $76 | $76 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $24 | $25 | $26 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $22 | $43 | $77 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $122 | $128 | $131 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $167 | $171 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $58 | $66 | $75 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $63 | $70 | $77 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $75 | $76 | $76 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $88 | $88 | $88 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $102 | $125 | $149 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $128 | $128 | $128 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $156 | $156 | $156 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $56 | $56 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $89 | $89 | $89 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $109 | $109 | $109 |
| Group psychotherapy CPT 90853 • Mental Health | $41 | $41 | $41 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $116 | $116 | $116 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $124 | $124 | $124 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $126 | $126 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $352 | $352 | $352 |