| Blood typing Rh CPT 86901 • Laboratory | $2 | $2 | $3 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $6 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $5 | $16 | $26 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $5 | $19 | $26 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $5 | $36 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $6 | $9 | $15 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $6 | $9 | $15 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $91 | $130 | $149 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $42 | $191 | $247 |
| Chorionic villus sampling CPT 59015 • Maternity | $42 | $126 | $187 |
| Fetal non-stress test CPT 59025 • Maternity | $43 | $52 | $57 |
| Insertion cervical dilator CPT 59200 • Maternity | $42 | $83 | $121 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $42 | $2,485 | $3,583 |
| Vaginal delivery only CPT 59409 • Maternity | $917 | $1,049 | $1,181 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $42 | $941 | $1,255 |
| External cephalic version CPT 59412 • Maternity | $117 | $122 | $125 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $912 | $949 | $968 |
| Postpartum care only CPT 59430 • Maternity | $219 | $247 | $304 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,295 | $3,313 | $3,964 |
| Cesarean delivery only CPT 59514 • Maternity | $1,035 | $1,086 | $1,111 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,490 | $1,675 | $1,841 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,523 | $2,609 | $2,866 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $111 | $154 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $143 | $170 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $141 | $172 | $204 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $37 | $48 | $65 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $42 | $85 | $122 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $17 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $141 | $178 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $136 | $192 | $263 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $71 | $88 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $63 | $82 | $93 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $67 | $99 | $126 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $92 | $107 | $137 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $133 | $160 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $91 | $124 | $158 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $138 | $167 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $80 | $81 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $113 | $126 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $107 | $132 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $37 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $72 | $147 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $42 | $122 | $155 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $152 | $153 | $156 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $323 | $371 | $434 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $256 | $438 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $107 | $113 | $129 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $150 | $159 | $185 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $76 | $86 |