| Blood typing Rh CPT 86901 • Laboratory | $2 | $3 | $6 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $11 | $11 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $28 | $29 | $30 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $28 | $29 | $30 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $49 | $50 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $14 | $15 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $13 | $15 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $112 | $154 | $237 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $195 | $308 | $421 |
| Chorionic villus sampling CPT 59015 • Maternity | $151 | $234 | $316 |
| Fetal non-stress test CPT 59025 • Maternity | $46 | $51 | $59 |
| Insertion cervical dilator CPT 59200 • Maternity | $94 | $99 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,338 | $2,660 | $3,304 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $943 | $1,264 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,035 | $1,188 | $1,494 |
| External cephalic version CPT 59412 • Maternity | $99 | $124 | $174 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $996 | $1,058 | $1,181 |
| Postpartum care only CPT 59430 • Maternity | $216 | $244 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,578 | $2,896 | $3,532 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $1,112 | $1,569 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,272 | $1,480 | $1,896 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,441 | $2,718 | $3,547 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $103 | $113 | $132 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $119 | $124 | $133 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $139 | $192 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $27 | $61 | $86 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $85 | $93 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $159 | $184 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $164 | $167 | $168 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $81 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $60 | $88 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $85 | $108 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $86 | $96 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $142 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $113 | $134 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $120 | $140 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $69 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $110 | $122 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $94 | $136 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $55 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $157 | $226 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $131 | $161 | $221 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $148 | $178 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $103 | $241 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $94 | $317 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $97 | $107 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $146 | $157 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $59 | $84 | $97 |