| Blood typing Rh CPT 86901 • Laboratory | $2 | $2 | $2 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $12 | $17 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $15 | $15 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $21 | $27 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $31 | $31 | $31 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $13 | $14 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $10 | $16 | $25 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $77 | $77 | $77 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $566 | $566 | $566 |
| Chorionic villus sampling CPT 59015 • Maternity | $149 | $149 | $149 |
| Fetal non-stress test CPT 59025 • Maternity | $28 | $46 | $56 |
| Insertion cervical dilator CPT 59200 • Maternity | $84 | $84 | $84 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,150 | $3,714 | $5,277 |
| Vaginal delivery only CPT 59409 • Maternity | $782 | $896 | $1,010 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,006 | $1,126 | $1,210 |
| External cephalic version CPT 59412 • Maternity | $289 | $289 | $289 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $797 | $896 | $994 |
| Postpartum care only CPT 59430 • Maternity | $393 | $393 | $393 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,549 | $4,191 | $5,833 |
| Cesarean delivery only CPT 59514 • Maternity | $881 | $1,037 | $1,193 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $3,157 | $3,157 | $3,157 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,137 | $2,286 | $2,360 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $117 | $147 | $178 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $146 | $165 | $184 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $133 | $134 | $134 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $62 | $79 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $31 | $85 | $132 |
| Interactive complexity add-on CPT 90785 • Mental Health | $44 | $44 | $44 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $125 | $133 | $137 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $181 | $272 | $455 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $62 | $62 | $62 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $206 | $206 | $206 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $69 | $81 | $92 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $261 | $261 | $261 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $103 | $114 | $124 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $343 | $343 | $343 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $380 | $380 | $380 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $200 | $200 | $200 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $126 | $211 | $295 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $104 | $104 | $104 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $27 | $27 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $178 | $197 | $215 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $127 | $127 | $127 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $125 | $142 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $384 | $827 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $403 | $421 | $440 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $62 | $62 | $62 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $82 | $82 | $82 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $116 | $133 |