| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $1 | $1 | $1 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $1 | $1 | $1 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $8 | $8 | $8 |
| Nuclear antigen antibody CPT 86235 • Laboratory | $11 | $11 | $11 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $3 | $3 | $3 |
| TB skin test intradermal CPT 86580 • Laboratory | $5 | $5 | $6 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $1 | $1 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $5 | $5 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $10 | $10 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $11 | $11 | $11 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $69 | $69 | $69 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $173 | $173 | $173 |
| Fetal non-stress test CPT 59025 • Maternity | $44 | $44 | $44 |
| Vaginal delivery only CPT 59409 • Maternity | $700 | $700 | $700 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $940 | $940 | $940 |
| External cephalic version CPT 59412 • Maternity | $88 | $88 | $88 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $912 | $912 | $912 |
| Postpartum care only CPT 59430 • Maternity | $236 | $236 | $236 |
| Cesarean delivery only CPT 59514 • Maternity | $785 | $785 | $785 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,131 | $1,131 | $1,131 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,198 | $2,198 | $2,198 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $104 | $104 | $104 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $127 | $127 | $127 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $87 | $87 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $4 | $4 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $150 | $175 | $200 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $151 | $152 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $82 | $82 | $82 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $106 | $106 | $106 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $81 | $101 | $121 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $98 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $124 | $124 | $124 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $185 | $185 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $163 | $163 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $59 | $69 | $79 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $103 | $125 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $157 | $157 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $46 | $46 | $46 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $56 | $56 | $56 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $124 | $126 | $127 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $351 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $412 | $412 | $412 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $103 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $144 | $144 | $144 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $49 | $49 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $104 | $105 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $74 | $74 | $74 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $165 | $165 | $165 |