| Prothrombin time (PT) CPT 85610 • Laboratory | $3 | $5 | $6 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $4 | $4 | $4 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $8 | $8 | $8 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $18 | $18 | $18 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $14 | $14 | $14 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $7 | $7 | $7 |
| Blood typing ABO CPT 86900 • Laboratory | $4 | $4 | $4 |
| Blood typing Rh CPT 86901 • Laboratory | $4 | $4 | $4 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $11 | $11 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $49 | $49 | $49 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $49 | $49 | $49 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $62 | $72 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $23 | $23 | $23 |
| Fetal non-stress test CPT 59025 • Maternity | $64 | $64 | $64 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $3,517 | $3,517 | $3,517 |
| Cesarean delivery only CPT 59514 • Maternity | $885 | $1,033 | $1,181 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $156 | $156 | $156 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $180 | $180 | $180 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $237 | $237 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $107 | $107 | $107 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $123 | $123 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $130 | $130 | $130 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $131 | $131 | $131 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $63 | $63 | $63 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $59 | $59 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $84 | $84 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $127 | $127 | $127 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $132 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $96 | $96 | $96 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $23 | $23 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $158 | $192 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $518 | $518 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $596 | $596 | $596 |
| EMG needle each extremity complete CPT 95886 • Neurology | $53 | $90 | $128 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $97 | $97 | $97 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $131 | $149 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $145 | $198 | $224 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $226 | $296 |
| Office visit established patient minimal CPT 99211 • Office Visits | $31 | $31 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $38 | $63 | $76 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $70 | $105 | $122 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $105 | $150 | $172 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $127 | $204 | $243 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $829 | $829 | $829 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,564 | $1,564 | $1,564 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $851 | $987 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $720 | $720 | $720 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $604 | $604 | $604 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $52 | $62 | $72 |