| Blood typing Rh CPT 86901 • Laboratory | $1 | $3 | $5 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $4 | $5 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $36 | $62 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $38 | $62 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $41 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $14 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $55 | $83 | $99 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $164 | $222 | $309 |
| Chorionic villus sampling CPT 59015 • Maternity | $127 | $141 | $162 |
| Fetal non-stress test CPT 59025 • Maternity | $14 | $30 | $38 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $70 | $86 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,885 | $2,412 | $3,150 |
| Vaginal delivery only CPT 59409 • Maternity | $639 | $674 | $721 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $797 | $873 |
| External cephalic version CPT 59412 • Maternity | $84 | $117 | $169 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $459 | $835 |
| Postpartum care only CPT 59430 • Maternity | $118 | $179 | $216 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,885 | $2,146 | $2,353 |
| Cesarean delivery only CPT 59514 • Maternity | $142 | $580 | $851 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $711 | $916 | $1,073 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,390 | $1,842 | $2,250 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $113 | $192 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $119 | $194 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $101 | $117 | $134 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $34 | $45 | $62 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $56 | $71 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $8 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $98 | $154 | $231 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $134 | $164 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $67 | $100 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $48 | $76 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $97 | $117 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $78 | $123 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $122 | $153 | $210 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $109 | $142 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $133 | $153 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $65 | $76 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $105 | $125 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $116 | $140 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $40 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $104 | $112 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $82 | $123 | $168 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $121 | $128 | $142 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $181 | $342 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $292 | $401 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $97 | $109 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $109 | $152 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $62 | $92 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $76 | $107 |