| Heterophile antibodies screen CPT 86308 • Laboratory | $3 | $3 | $3 |
| TB skin test intradermal CPT 86580 • Laboratory | $4 | $5 | $6 |
| Blood typing ABO CPT 86900 • Laboratory | $1 | $2 | $2 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $1 | $1 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $3 | $3 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $15 | $15 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $20 | $26 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $31 | $31 | $31 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $14 | $14 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $10 | $11 | $12 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $50 | $98 | $147 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $173 | $198 | $248 |
| Chorionic villus sampling CPT 59015 • Maternity | $112 | $137 | $161 |
| Fetal non-stress test CPT 59025 • Maternity | $42 | $47 | $58 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $55 | $55 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $50 | $1,324 | $2,598 |
| Vaginal delivery only CPT 59409 • Maternity | $50 | $522 | $994 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $50 | $751 | $1,279 |
| External cephalic version CPT 59412 • Maternity | $50 | $88 | $127 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,016 | $1,016 | $1,016 |
| Postpartum care only CPT 59430 • Maternity | $252 | $252 | $252 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,025 | $2,453 | $2,881 |
| Cesarean delivery only CPT 59514 • Maternity | $50 | $586 | $1,123 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $50 | $804 | $1,558 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,025 | $2,261 | $2,734 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $60 | $60 | $60 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $50 | $108 | $167 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $212 | $212 | $212 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $50 | $56 | $61 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $69 | $69 | $70 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $17 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $170 | $175 | $177 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $179 | $182 | $188 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $73 | $78 | $83 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $76 | $81 | $85 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $90 | $100 | $111 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $98 | $99 | $100 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $145 | $155 | $166 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $139 | $142 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $173 | $175 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $83 | $85 | $88 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $113 | $117 | $120 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $118 | $121 | $125 |
| Group psychotherapy CPT 90853 • Mental Health | $33 | $43 | $53 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $50 | $109 | $168 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $17 | $69 | $141 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $161 | $161 | $161 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $435 | $435 | $435 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $516 | $516 | $516 |