| Blood typing ABO CPT 86900 • Laboratory | $4 | $4 | $4 |
| Blood typing Rh CPT 86901 • Laboratory | $4 | $4 | $4 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $10 | $10 | $10 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $24 | $34 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $26 | $34 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $28 | $40 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $11 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $41 | $41 | $41 |
| Chorionic villus sampling CPT 59015 • Maternity | $157 | $157 | $157 |
| Fetal non-stress test CPT 59025 • Maternity | $27 | $38 | $49 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,861 | $1,981 | $2,100 |
| Vaginal delivery only CPT 59409 • Maternity | $41 | $345 | $649 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $913 | $913 | $913 |
| External cephalic version CPT 59412 • Maternity | $41 | $41 | $41 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $759 | $759 | $759 |
| Postpartum care only CPT 59430 • Maternity | $157 | $186 | $216 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,100 | $2,156 | $2,212 |
| Cesarean delivery only CPT 59514 • Maternity | $41 | $41 | $41 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $41 | $41 | $41 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $41 | $41 | $41 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $45 | $70 | $95 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $127 | $145 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $170 | $180 | $190 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $41 | $53 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $70 | $84 | $99 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $12 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $163 | $221 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $167 | $184 | $202 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $90 | $111 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $97 | $123 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $78 | $117 | $156 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $98 | $120 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $123 | $172 | $222 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $105 | $117 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $155 | $165 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $46 | $46 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $117 | $156 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $87 | $98 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $22 | $22 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $151 | $151 | $151 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $41 | $41 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $112 | $112 | $112 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $303 | $303 | $303 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $51 | $215 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $90 | $90 | $90 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $130 | $130 | $130 |
| EMG needle each extremity complete CPT 95886 • Neurology | $84 | $84 | $84 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $112 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |