| TB skin test intradermal CPT 86580 • Laboratory | $4 | $6 | $9 |
| 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 | $18 | $23 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $18 | $18 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $28 | $44 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $6 | $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 | $30 | $30 | $30 |
| Fetal non-stress test CPT 59025 • Maternity | $10 | $19 | $27 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $36 | $41 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,861 | $1,861 | $1,861 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $419 | $1,181 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,041 | $1,041 | $1,041 |
| External cephalic version CPT 59412 • 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 | $3,082 | $3,964 |
| Cesarean delivery only CPT 59514 • Maternity | $45 | $45 | $45 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $935 | $1,841 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,350 | $2,350 | $2,350 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $77 | $116 | $154 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $45 | $77 | $110 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $154 | $162 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $43 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $24 | $67 | $89 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $10 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $102 | $150 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $151 | $157 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $68 | $79 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $76 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $103 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $53 | $87 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $101 | $107 | $119 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $117 | $136 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $114 | $134 | $145 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $75 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $113 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $101 | $120 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $42 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $45 | $45 | $45 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $275 | $343 | $387 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $319 | $363 | $407 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $94 | $103 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $160 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $70 | $78 | $86 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $96 | $102 |