| Blood typing Rh CPT 86901 • Laboratory | $1 | $4 | $6 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $11 | $16 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $49 | $71 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $49 | $71 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $52 | $85 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $19 | $27 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $143 | $192 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $240 | $318 |
| Chorionic villus sampling CPT 59015 • Maternity | $85 | $171 | $255 |
| Fetal non-stress test CPT 59025 • Maternity | $28 | $50 | $80 |
| Insertion cervical dilator CPT 59200 • Maternity | $46 | $71 | $99 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,072 | $3,369 | $7,103 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $981 | $1,267 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,322 | $1,719 |
| External cephalic version CPT 59412 • Maternity | $71 | $114 | $163 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $1,008 | $1,663 |
| Postpartum care only CPT 59430 • Maternity | $118 | $232 | $426 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $2,800 | $4,299 |
| Cesarean delivery only CPT 59514 • Maternity | $639 | $1,004 | $1,433 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $711 | $1,272 | $2,128 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,182 | $2,673 | $4,052 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $97 | $157 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $53 | $91 | $174 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $237 | $294 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $89 | $126 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $88 | $120 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $15 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $202 | $280 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $186 | $315 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $73 | $97 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $30 | $55 | $90 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $110 | $174 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $96 | $155 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $201 | $304 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $147 | $205 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $197 | $249 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $85 | $110 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $117 | $164 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $134 | $171 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $38 | $47 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $75 | $109 | $176 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $82 | $163 | $226 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $156 | $226 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $90 | $204 | $324 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $90 | $210 | $312 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $82 | $100 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $69 | $141 | $255 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $70 | $104 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $101 | $164 |