| Nuclear antigen antibody CPT 86235 • Laboratory | $7 | $7 | $7 |
| Heterophile antibodies screen CPT 86308 • Laboratory | $4 | $4 | $4 |
| TB skin test intradermal CPT 86580 • Laboratory | $7 | $7 | $7 |
| 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 | $28 | $28 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $13 | $13 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $11 | $12 | $13 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $112 | $112 | $112 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $195 | $195 | $195 |
| Fetal non-stress test CPT 59025 • Maternity | $40 | $40 | $40 |
| Insertion cervical dilator CPT 59200 • Maternity | $104 | $104 | $104 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,338 | $2,338 | $2,338 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $783 | $784 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $849 | $849 | $849 |
| External cephalic version CPT 59412 • Maternity | $99 | $99 | $99 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $996 | $996 | $996 |
| Postpartum care only CPT 59430 • Maternity | $258 | $258 | $258 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $884 | $884 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,272 | $1,272 | $1,273 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,003 | $2,003 | $2,003 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $103 | $103 | $103 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $119 | $119 | $119 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $81 | $117 | $154 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $72 | $72 | $72 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $83 | $83 | $83 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $8 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $155 | $177 | $209 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $154 | $170 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $61 | $82 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $89 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $107 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $106 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $119 | $151 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $94 | $116 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $101 | $138 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $63 | $69 | $79 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $95 | $103 | $114 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $116 | $128 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $55 | $69 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $132 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $338 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $113 | $114 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $162 | $162 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $90 |