| Nuclear antigen antibody CPT 86235 • Laboratory | $5 | $5 | $5 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $2 | $4 | $5 |
| TB skin test intradermal CPT 86580 • Laboratory | $5 | $7 | $10 |
| Blood typing ABO CPT 86900 • Laboratory | $2 | $2 | $2 |
| Blood typing Rh CPT 86901 • Laboratory | $5 | $5 | $5 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $5 | $5 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $19 | $23 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $5 | $11 | $18 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $5 | $32 | $62 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $12 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $96 | $96 | $96 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $245 | $245 | $245 |
| Chorionic villus sampling CPT 59015 • Maternity | $180 | $180 | $180 |
| Fetal non-stress test CPT 59025 • Maternity | $27 | $32 | $36 |
| Insertion cervical dilator CPT 59200 • Maternity | $54 | $54 | $54 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,850 | $1,856 | $1,861 |
| Vaginal delivery only CPT 59409 • Maternity | $649 | $789 | $929 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,038 | $1,038 | $1,038 |
| External cephalic version CPT 59412 • Maternity | $123 | $123 | $123 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $750 | $750 | $750 |
| Postpartum care only CPT 59430 • Maternity | $163 | $189 | $216 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,097 | $2,154 | $2,212 |
| Cesarean delivery only CPT 59514 • Maternity | $1,096 | $1,096 | $1,096 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,237 | $1,237 | $1,237 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,954 | $1,954 | $1,954 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $95 | $117 | $140 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $84 | $97 | $110 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $109 | $139 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $37 | $51 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $42 | $56 | $70 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $7 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $171 | $229 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $149 | $182 | $229 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $80 | $111 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $50 | $81 | $123 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $78 | $110 | $156 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $79 | $81 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $123 | $151 | $189 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $111 | $130 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $145 | $145 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $46 | $46 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $91 | $103 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $126 | $180 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $29 | $35 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $77 | $77 | $77 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $148 | $148 | $148 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $129 | $129 | $129 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $64 | $64 | $64 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $164 | $271 | $379 |