| Iron binding capacity CPT 83550 • Laboratory | $4 | $4 | $4 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $3 | $6 | $8 |
| Free thyroxine (T4) CPT 84439 • Laboratory | $4 | $6 | $8 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $3 | $5 | $7 |
| Complete blood count with differential CPT 85025 • Laboratory | $3 | $3 | $4 |
| Complete blood count automated CPT 85027 • Laboratory | $3 | $4 | $6 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $1 | $2 | $3 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $1 | $2 | $3 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $1 | $2 | $3 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $5 | $9 | $12 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $8 | $12 | $17 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $1 | $2 | $3 |
| TB skin test intradermal CPT 86580 • Laboratory | $4 | $5 | $6 |
| Blood typing ABO CPT 86900 • Laboratory | $1 | $1 | $1 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $1 | $1 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $4 | $4 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $6 | $10 | $15 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $21 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $28 | $31 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $6 | $10 | $14 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $10 | $11 | $11 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $106 | $106 | $106 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $18 | $99 | $180 |
| Chorionic villus sampling CPT 59015 • Maternity | $27 | $83 | $138 |
| Fetal non-stress test CPT 59025 • Maternity | $13 | $27 | $42 |
| Insertion cervical dilator CPT 59200 • Maternity | $20 | $52 | $84 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,030 | $2,065 | $2,100 |
| Vaginal delivery only CPT 59409 • Maternity | $338 | $557 | $776 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $158 | $543 | $929 |
| External cephalic version CPT 59412 • Maternity | $45 | $72 | $99 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $69 | $432 | $794 |
| Postpartum care only CPT 59430 • Maternity | $110 | $146 | $183 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $420 | $1,336 | $2,252 |
| Cesarean delivery only CPT 59514 • Maternity | $161 | $488 | $816 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $954 | $1,043 | $1,132 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,050 | $1,518 | $1,986 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $39 | $82 | $125 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $51 | $54 | $58 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $53 | $62 | $71 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $28 | $41 | $54 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $59 | $60 | $62 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $9 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $107 | $109 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $93 | $107 | $121 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $58 | $64 | $70 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $62 | $66 | $70 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $80 | $86 | $92 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $78 | $78 | $79 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $79 | $104 | $129 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $79 | $87 | $94 |