| 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 | $24 | $24 | $24 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $24 | $24 | $24 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $43 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $12 | $13 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $8 | $12 | $13 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $120 | $171 | $197 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $195 | $282 | $326 |
| Chorionic villus sampling CPT 59015 • Maternity | $127 | $207 | $247 |
| Fetal non-stress test CPT 59025 • Maternity | $15 | $55 | $75 |
| Insertion cervical dilator CPT 59200 • Maternity | $43 | $77 | $114 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,709 | $2,797 | $3,342 |
| Vaginal delivery only CPT 59409 • Maternity | $736 | $1,122 | $1,315 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $860 | $1,403 | $1,675 |
| External cephalic version CPT 59412 • Maternity | $99 | $144 | $166 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $615 | $1,068 | $1,295 |
| Postpartum care only CPT 59430 • Maternity | $132 | $239 | $293 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,935 | $3,107 | $3,693 |
| Cesarean delivery only CPT 59514 • Maternity | $873 | $1,277 | $1,479 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,040 | $1,697 | $2,026 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,799 | $2,933 | $3,501 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $124 | $124 | $124 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $139 | $139 | $139 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $96 | $96 | $96 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $33 | $33 | $33 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $97 | $97 | $97 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $15 | $20 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $127 | $172 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $135 | $183 | $203 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $67 | $83 | $91 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $77 | $93 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $80 | $107 | $121 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $73 | $103 | $118 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $121 | $161 | $181 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $118 | $143 | $155 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $189 | $189 | $189 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $91 | $91 | $91 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $89 | $127 | $146 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $137 | $151 |
| Group psychotherapy CPT 90853 • Mental Health | $32 | $35 | $37 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $77 | $192 | $249 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $140 | $181 | $212 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $167 | $190 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $236 | $395 | $474 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $258 | $447 | $541 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $127 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $142 | $229 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $97 | $125 |