| Blood typing Rh CPT 86901 • Laboratory | $2 | $3 | $5 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $5 | $5 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $23 | $25 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $5 | $20 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $5 | $36 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $13 | $13 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $5 | $11 | $13 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $96 | $107 | $112 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $195 | $220 | $245 |
| Chorionic villus sampling CPT 59015 • Maternity | $151 | $166 | $180 |
| Fetal non-stress test CPT 59025 • Maternity | $36 | $43 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $54 | $79 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,850 | $2,175 | $2,338 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $832 | $929 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,035 | $1,036 | $1,038 |
| External cephalic version CPT 59412 • Maternity | $99 | $107 | $123 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $750 | $914 | $996 |
| Postpartum care only CPT 59430 • Maternity | $163 | $226 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,097 | $2,418 | $2,578 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $955 | $1,096 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,237 | $1,254 | $1,272 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,954 | $2,319 | $2,441 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $103 | $115 | $140 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $84 | $107 | $119 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $87 | $109 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $27 | $45 | $71 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $42 | $69 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $138 | $171 | $184 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $149 | $163 | $168 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $81 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $50 | $85 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $96 | $107 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $98 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $138 | $154 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $130 | $139 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $150 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $82 | $82 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $103 | $121 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $123 | $146 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $35 | $51 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $77 | $108 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $131 | $137 | $148 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $129 | $132 | $133 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $64 | $228 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $164 | $341 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $58 | $98 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $128 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $99 | $102 |