| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $7 | $11 | $13 |
| Complete blood count with differential CPT 85025 • Laboratory | $4 | $5 | $6 |
| Complete blood count automated CPT 85027 • Laboratory | $5 | $6 | $6 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $3 | $4 | $4 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $2 | $2 | $3 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $5 | $5 | $5 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $10 | $10 | $10 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $14 | $14 | $14 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $2 | $3 | $4 |
| TB skin test intradermal CPT 86580 • Laboratory | $4 | $7 | $8 |
| 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 | $3 | $5 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $18 | $25 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $25 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $43 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $8 | $8 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $194 | $430 | $903 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $318 | $332 | $360 |
| Chorionic villus sampling CPT 59015 • Maternity | $242 | $462 | $903 |
| Fetal non-stress test CPT 59025 • Maternity | $74 | $170 | $360 |
| Insertion cervical dilator CPT 59200 • Maternity | $111 | $194 | $360 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,170 | $2,745 | $3,287 |
| Vaginal delivery only CPT 59409 • Maternity | $1,279 | $2,159 | $3,920 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $878 | $1,328 | $1,631 |
| External cephalic version CPT 59412 • Maternity | $162 | $1,415 | $3,920 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $903 | $1,152 | $1,267 |
| Postpartum care only CPT 59430 • Maternity | $287 | $581 | $1,170 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,170 | $3,008 | $3,631 |
| Cesarean delivery only CPT 59514 • Maternity | $1,170 | $1,350 | $1,440 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,170 | $1,709 | $1,979 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,170 | $2,675 | $3,427 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $168 | $184 | $191 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $185 | $208 | $220 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $286 | $286 | $286 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $61 | $108 | $131 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $133 | $145 | $151 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $165 | $165 | $165 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $194 | $194 | $194 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $53 | $53 | $53 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $131 | $151 | $185 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $106 | $106 | $106 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $244 | $464 | $903 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $129 | $223 | $360 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $195 | $250 | $360 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $166 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $430 | $477 | $572 |
| EMG needle each extremity complete CPT 95886 • Neurology | $84 | $84 | $84 |