| Blood typing Rh CPT 86901 • Laboratory | $1 | $3 | $5 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $8 | $15 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $33 | $60 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $34 | $60 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $44 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $6 | $12 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $83 | $444 | $1,801 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $134 | $308 | $824 |
| Chorionic villus sampling CPT 59015 • Maternity | $134 | $496 | $1,801 |
| Fetal non-stress test CPT 59025 • Maternity | $29 | $196 | $824 |
| Insertion cervical dilator CPT 59200 • Maternity | $47 | $216 | $824 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,323 | $2,016 | $2,473 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $1,826 | $4,928 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,295 | $1,708 |
| External cephalic version CPT 59412 • Maternity | $97 | $1,068 | $4,928 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $674 | $1,708 |
| Postpartum care only CPT 59430 • Maternity | $118 | $484 | $1,708 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,708 | $2,474 | $3,530 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $1,234 | $1,708 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,381 | $1,708 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,390 | $2,072 | $2,523 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $81 | $117 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $98 | $136 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $92 | $116 | $153 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $73 | $130 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $33 | $50 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $8 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $98 | $160 | $203 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $155 | $183 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $61 | $78 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $63 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $97 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $84 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $122 | $178 | $304 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $122 | $146 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $144 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $70 | $85 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $108 | $133 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $122 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $43 | $69 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $49 | $437 | $1,801 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $294 | $824 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $95 | $268 | $824 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $145 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $239 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $88 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $69 | $97 | $150 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $79 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $60 | $89 |