| Diagnostic mammography bilateral CPT 77066 • Imaging | $160 | $160 | $160 |
| Screening mammography bilateral CPT 77067 • Imaging | $112 | $121 | $129 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $391 | $423 | $455 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $2 | $2 |
| Basic metabolic panel CPT 80048 • Laboratory | $7 | $7 | $7 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $8 | $8 | $8 |
| Lipid panel CPT 80061 • Laboratory | $11 | $11 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $7 | $7 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $3 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $2 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $2 | $2 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $14 | $14 | $14 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $25 | $25 | $25 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $5 | $5 | $5 |
| Ferritin CPT 82728 • Laboratory | $12 | $12 | $12 |
| Iron serum CPT 83540 • Laboratory | $1 | $1 | $1 |
| Iron binding capacity CPT 83550 • Laboratory | $7 | $7 | $7 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $12 | $12 | $12 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $7 | $7 | $7 |
| Complete blood count with differential CPT 85025 • Laboratory | $6 | $6 | $6 |
| Complete blood count automated CPT 85027 • Laboratory | $1 | $1 | $1 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $3 | $3 | $3 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $2 | $2 | $2 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $5 | $5 | $5 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $10 | $11 | $11 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $7 | $7 | $7 |
| TB skin test intradermal CPT 86580 • Laboratory | $10 | $10 | $10 |
| Blood typing ABO CPT 86900 • Laboratory | $2 | $2 | $2 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $2 | $2 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $26 | $27 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $28 | $28 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $14 | $14 | $14 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $30 | $30 | $30 |
| Fetal non-stress test CPT 59025 • Maternity | $46 | $46 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $30 | $30 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,284 | $2,284 | $2,284 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $30 | $30 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,006 | $1,006 | $1,006 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $30 | $30 | $30 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $533 | $1,035 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $1,211 | $2,392 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $154 | $154 | $154 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $30 | $30 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $35 | $66 | $97 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $11 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $127 | $159 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $162 | $177 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $78 | $85 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $76 | $89 | $102 |