| Free thyroxine (T4) CPT 84439 • Laboratory | $4 | $4 | $4 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $7 | $7 | $7 |
| Complete blood count with differential CPT 85025 • Laboratory | $3 | $3 | $3 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $7 | $7 | $7 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $1 | $1 | $1 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $2 | $2 | $2 |
| TB skin test intradermal CPT 86580 • Laboratory | $15 | $15 | $15 |
| 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 | $4 | $4 | $4 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $15 | $15 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $15 | $15 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $26 | $26 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $8 | $8 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $105 | $105 | $105 |
| Fetal non-stress test CPT 59025 • Maternity | $77 | $77 | $77 |
| Insertion cervical dilator CPT 59200 • Maternity | $53 | $53 | $53 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,700 | $2,700 | $2,700 |
| Vaginal delivery only CPT 59409 • Maternity | $689 | $689 | $689 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $932 | $932 | $932 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $742 | $742 | $742 |
| Postpartum care only CPT 59430 • Maternity | $399 | $399 | $399 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $3,749 | $3,749 | $3,749 |
| Cesarean delivery only CPT 59514 • Maternity | $781 | $781 | $781 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,083 | $1,083 | $1,083 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,055 | $2,055 | $2,055 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $73 | $105 | $137 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $47 | $109 | $170 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $68 | $113 | $157 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $24 | $60 | $97 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $27 | $69 | $111 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $106 | $106 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $324 | $324 | $324 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $85 | $85 | $85 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $54 | $54 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $113 | $113 | $113 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $90 | $90 | $90 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $121 | $121 | $121 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $129 | $129 | $129 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $83 | $83 | $83 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $125 | $125 | $125 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $96 | $96 | $96 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $90 | $90 | $90 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $386 | $386 | $386 |
| EMG needle each extremity complete CPT 95886 • Neurology | $141 | $141 | $141 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $201 | $201 | $201 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $432 | $432 | $432 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $73 | $73 | $73 |