| TB skin test intradermal CPT 86580 • Laboratory | $5 | $5 | $6 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $2 | $2 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $6 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $15 | $15 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $15 | $15 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $28 | $40 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $9 | $11 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $8 | $10 | $12 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $45 | $45 | $45 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $45 | $45 | $45 |
| Fetal non-stress test CPT 59025 • Maternity | $27 | $35 | $43 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $45 | $953 | $1,861 |
| Vaginal delivery only CPT 59409 • Maternity | $45 | $347 | $649 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $45 | $45 | $45 |
| Postpartum care only CPT 59430 • Maternity | $216 | $216 | $216 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $2,206 | $2,212 |
| Cesarean delivery only CPT 59514 • Maternity | $45 | $45 | $45 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $45 | $45 | $45 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $45 | $45 | $45 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $95 | $99 | $104 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $45 | $77 | $110 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $170 | $170 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $66 | $66 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $31 | $59 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $7 | $11 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $116 | $164 | $200 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $150 | $155 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $72 | $80 | $84 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $82 | $106 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $68 | $95 | $121 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $97 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $116 | $120 | $125 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $141 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $118 | $135 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $58 | $72 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $105 | $125 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $119 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $32 | $46 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $45 | $45 | $45 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $45 | $45 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $351 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $319 | $349 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $94 | $94 | $94 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $134 | $134 | $134 |
| EMG needle each extremity complete CPT 95886 • Neurology | $70 | $70 | $70 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $75 | $75 | $75 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $153 | $153 | $153 |