| Complete blood count with differential CPT 85025 • Laboratory | $5 | $9 | $11 |
| Complete blood count automated CPT 85027 • Laboratory | $3 | $7 | $9 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $2 | $4 | $6 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $2 | $3 | $4 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $4 | $7 | $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 | $3 | $6 | $7 |
| TB skin test intradermal CPT 86580 • Laboratory | $5 | $5 | $5 |
| 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 | $3 | $9 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $38 | $49 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $38 | $49 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $32 | $52 | $72 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $18 | $23 |
| Fetal non-stress test CPT 59025 • Maternity | $33 | $54 | $64 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $55 | $55 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,453 | $2,453 | $2,453 |
| Vaginal delivery only CPT 59409 • Maternity | $795 | $795 | $795 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,031 | $1,031 | $1,031 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $250 | $250 | $250 |
| Postpartum care only CPT 59430 • Maternity | $210 | $210 | $210 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,579 | $3,205 | $3,517 |
| Cesarean delivery only CPT 59514 • Maternity | $148 | $738 | $1,181 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,366 | $1,366 | $1,366 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,429 | $2,429 | $2,429 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $38 | $116 | $156 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $115 | $158 | $180 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $83 | $185 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $24 | $80 | $107 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $83 | $109 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $157 | $157 | $157 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $205 | $205 | $205 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $78 | $78 | $78 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $82 | $82 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $84 | $84 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $99 | $99 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $105 | $105 | $105 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $120 | $120 | $120 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $56 | $56 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $104 | $104 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $102 | $102 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $158 | $192 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $69 | $368 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $596 | $596 | $596 |