| Complete blood count with differential CPT 85025 • Laboratory | $5 | $6 | $7 |
| Complete blood count automated CPT 85027 • Laboratory | $4 | $5 | $6 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $3 | $3 | $4 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $1 | $2 | $2 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $4 | $5 | $6 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $8 | $10 | $12 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $10 | $13 | $17 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $3 | $4 | $5 |
| TB skin test intradermal CPT 86580 • Laboratory | $4 | $5 | $7 |
| Blood typing ABO CPT 86900 • Laboratory | $2 | $2 | $3 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $2 | $3 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $6 | $7 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $23 | $28 | $32 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $21 | $25 | $32 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $31 | $38 | $52 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $12 | $18 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $8 | $11 | $14 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $58 | $58 | $58 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $145 | $145 | $145 |
| Chorionic villus sampling CPT 59015 • Maternity | $95 | $95 | $95 |
| Fetal non-stress test CPT 59025 • Maternity | $53 | $61 | $68 |
| Insertion cervical dilator CPT 59200 • Maternity | $20 | $20 | $20 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,632 | $3,002 | $3,373 |
| Vaginal delivery only CPT 59409 • Maternity | $364 | $364 | $364 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $781 | $781 | $781 |
| External cephalic version CPT 59412 • Maternity | $74 | $74 | $74 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $575 | $575 | $575 |
| Postpartum care only CPT 59430 • Maternity | $82 | $82 | $82 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,926 | $2,926 | $2,926 |
| Cesarean delivery only CPT 59514 • Maternity | $92 | $92 | $92 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $611 | $611 | $611 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,759 | $2,759 | $2,759 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $33 | $33 | $33 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $34 | $34 | $34 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $64 | $64 | $64 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $22 | $35 | $49 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $58 | $62 | $67 |
| Interactive complexity add-on CPT 90785 • Mental Health | $11 | $13 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $124 | $142 | $160 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $122 | $164 | $205 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $49 | $72 | $95 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $46 | $63 | $80 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $75 | $100 | $126 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $66 | $88 | $110 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $110 | $135 | $160 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $87 | $131 | $175 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $106 | $134 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $47 | $47 | $47 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $70 | $70 | $70 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $73 | $84 | $115 |