| Prothrombin time (PT) CPT 85610 • Laboratory | $2 | $2 | $3 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $1 | $1 | $1 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $3 | $3 | $3 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $6 | $6 | $6 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $9 | $11 | $13 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $3 | $3 | $3 |
| TB skin test intradermal CPT 86580 • Laboratory | $3 | $3 | $3 |
| 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 | $4 | $5 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $17 | $21 | $25 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $21 | $25 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $21 | $21 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $7 | $7 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $26 | $26 | $26 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $157 | $157 | $157 |
| Chorionic villus sampling CPT 59015 • Maternity | $102 | $102 | $102 |
| Fetal non-stress test CPT 59025 • Maternity | $26 | $26 | $26 |
| Insertion cervical dilator CPT 59200 • Maternity | $14 | $14 | $14 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,893 | $1,893 | $1,893 |
| Vaginal delivery only CPT 59409 • Maternity | $415 | $415 | $415 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $354 | $354 | $354 |
| External cephalic version CPT 59412 • Maternity | $53 | $53 | $53 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $620 | $620 | $620 |
| Postpartum care only CPT 59430 • Maternity | $59 | $59 | $59 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,105 | $2,105 | $2,105 |
| Cesarean delivery only CPT 59514 • Maternity | $471 | $471 | $471 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $440 | $440 | $440 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,323 | $1,323 | $1,323 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $91 | $91 | $91 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $106 | $106 | $106 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $46 | $46 | $46 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $63 | $63 | $63 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $30 | $30 | $30 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $2 | $2 | $2 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $33 | $33 | $33 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $93 | $93 | $93 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $57 | $57 | $57 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $29 | $29 | $29 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $207 | $207 | $207 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $33 | $33 | $33 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $83 | $83 | $83 |
| EMG needle each extremity complete CPT 95886 • Neurology | $27 | $27 | $27 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $24 | $24 | $24 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $40 | $40 | $40 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $53 | $53 | $53 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $37 | $37 | $37 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $57 | $57 | $57 |