| Iron binding capacity CPT 83550 • Laboratory | $6 | $8 | $8 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $10 | $12 | $14 |
| Free thyroxine (T4) CPT 84439 • Laboratory | $7 | $7 | $8 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $10 | $13 | $15 |
| Complete blood count with differential CPT 85025 • Laboratory | $5 | $6 | $7 |
| Complete blood count automated CPT 85027 • Laboratory | $5 | $6 | $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 | $10 | $11 | $12 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $10 | $13 | $17 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $4 | $4 | $5 |
| TB skin test intradermal CPT 86580 • Laboratory | $4 | $5 | $5 |
| 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 | $6 | $7 | $7 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $26 | $30 | $32 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $21 | $24 | $26 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $27 | $37 | $52 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $11 | $15 | $18 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $9 | $10 | $11 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $197 | $197 | $197 |
| Fetal non-stress test CPT 59025 • Maternity | $56 | $56 | $56 |
| Insertion cervical dilator CPT 59200 • Maternity | $109 | $109 | $109 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $783 | $783 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,153 | $1,153 | $1,153 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,284 | $1,284 | $1,284 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $51 | $51 | $51 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $165 | $165 | $165 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $78 | $78 | $78 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $115 | $115 | $115 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $14 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $161 | $161 | $161 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $165 | $165 | $165 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $64 | $64 | $64 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $92 | $92 | $92 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $108 | $108 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $65 | $65 | $65 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $87 | $87 | $87 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $77 | $77 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $143 | $143 | $143 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $143 | $143 | $143 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $391 | $391 | $391 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $163 | $163 | $163 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $159 | $159 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $162 | $162 | $162 |