| Blood typing Rh CPT 86901 • Laboratory | $2 | $4 | $6 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $7 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $13 | $32 | $48 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $22 | $34 | $48 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $61 | $97 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $16 | $21 | $27 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $88 | $148 | $211 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $134 | $209 | $278 |
| Chorionic villus sampling CPT 59015 • Maternity | $138 | $172 | $217 |
| Fetal non-stress test CPT 59025 • Maternity | $27 | $50 | $86 |
| Insertion cervical dilator CPT 59200 • Maternity | $45 | $92 | $141 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,086 | $3,094 | $4,317 |
| Vaginal delivery only CPT 59409 • Maternity | $865 | $1,139 | $1,465 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $1,255 | $1,665 |
| External cephalic version CPT 59412 • Maternity | $105 | $125 | $142 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $861 | $1,269 | $1,845 |
| Postpartum care only CPT 59430 • Maternity | $92 | $307 | $482 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,955 | $2,705 | $3,658 |
| Cesarean delivery only CPT 59514 • Maternity | $200 | $1,016 | $1,627 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $802 | $1,776 | $2,830 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,390 | $2,473 | $3,462 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $128 | $224 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $84 | $156 | $258 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $118 | $221 | $328 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $73 | $109 | $155 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $78 | $108 | $177 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $14 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $209 | $269 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $195 | $245 | $297 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $87 | $104 | $132 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $82 | $101 | $135 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $87 | $127 | $187 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $112 | $196 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $109 | $189 | $262 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $123 | $163 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $159 | $199 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $74 | $84 | $94 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $105 | $144 | $224 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $136 | $206 |
| Group psychotherapy CPT 90853 • Mental Health | $32 | $46 | $80 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $154 | $245 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $73 | $170 | $262 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $142 | $189 | $268 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $437 | $792 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $312 | $580 | $930 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $95 | $152 | $234 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $127 | $214 | $338 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $105 | $206 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $74 | $112 | $187 |