| Iron binding capacity CPT 83550 • Laboratory | $1 | $4 | $6 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $3 | $3 | $3 |
| Free thyroxine (T4) CPT 84439 • Laboratory | $1 | $4 | $6 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $12 | $12 | $12 |
| Complete blood count with differential CPT 85025 • Laboratory | $1 | $3 | $5 |
| Complete blood count automated CPT 85027 • Laboratory | $4 | $6 | $8 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $1 | $2 | $2 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $0 | $1 | $2 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $2 | $2 | $2 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $9 | $9 | $10 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $7 | $7 | $7 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $3 | $3 | $4 |
| TB skin test intradermal CPT 86580 • Laboratory | $3 | $4 | $5 |
| Blood typing ABO CPT 86900 • Laboratory | $1 | $2 | $2 |
| Blood typing Rh CPT 86901 • Laboratory | $0 | $1 | $2 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $6 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $42 | $42 | $42 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $42 | $42 | $42 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $38 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $6 | $6 | $6 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $6 | $6 | $6 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $149 | $149 | $150 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $42 | $83 | $123 |
| Chorionic villus sampling CPT 59015 • Maternity | $42 | $91 | $140 |
| Fetal non-stress test CPT 59025 • Maternity | $35 | $35 | $36 |
| Insertion cervical dilator CPT 59200 • Maternity | $42 | $42 | $42 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $42 | $639 | $1,237 |
| Vaginal delivery only CPT 59409 • Maternity | $492 | $737 | $983 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $42 | $649 | $1,255 |
| External cephalic version CPT 59412 • Maternity | $63 | $94 | $125 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $755 | $861 | $968 |
| Postpartum care only CPT 59430 • Maternity | $167 | $193 | $219 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $42 | $42 | $42 |
| Cesarean delivery only CPT 59514 • Maternity | $42 | $577 | $1,111 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $42 | $174 | $306 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,262 | $1,892 | $2,523 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $48 | $71 | $95 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $42 | $76 | $110 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $75 | $75 | $75 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $41 | $41 | $42 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $29 | $29 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $15 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $152 | $152 | $152 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $156 | $170 | $183 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $75 | $81 | $88 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $80 | $86 | $93 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $107 | $107 | $108 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $103 | $110 | $117 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $98 | $114 | $131 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $138 | $158 |