| Blood typing Rh CPT 86901 • Laboratory | $2 | $4 | $5 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $10 | $14 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $25 | $40 | $62 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $25 | $40 | $62 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $56 | $72 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $14 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $83 | $173 | $254 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $343 | $637 |
| Chorionic villus sampling CPT 59015 • Maternity | $134 | $248 | $414 |
| Fetal non-stress test CPT 59025 • Maternity | $37 | $60 | $92 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $102 | $140 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $3,588 | $6,245 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $1,798 | $3,150 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $2,053 | $3,150 |
| External cephalic version CPT 59412 • Maternity | $97 | $175 | $325 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $1,204 | $3,270 |
| Postpartum care only CPT 59430 • Maternity | $118 | $295 | $572 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,853 | $6,890 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $1,916 | $3,150 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $2,293 | $3,390 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,250 | $3,713 | $6,522 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $152 | $321 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $135 | $237 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $243 | $481 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $99 | $199 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $34 | $89 | $142 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $16 | $49 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $122 | $229 | $496 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $130 | $264 | $638 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $110 | $247 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $99 | $203 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $148 | $326 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $134 | $286 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $236 | $480 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $116 | $178 | $379 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $140 | $224 | $461 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $112 | $228 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $108 | $157 | $314 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $113 | $167 | $326 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $47 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $175 | $335 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $269 | $434 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $238 | $342 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $529 | $1,206 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $635 | $1,398 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $184 | $358 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $78 | $154 | $253 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $122 | $175 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $43 | $144 | $287 |