| Blood typing Rh CPT 86901 • Laboratory | $1 | $3 | $6 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $8 | $10 | $12 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $33 | $51 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $22 | $50 | $80 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $72 | $156 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $19 | $24 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $91 | $278 | $703 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $270 | $375 |
| Chorionic villus sampling CPT 59015 • Maternity | $138 | $363 | $907 |
| Fetal non-stress test CPT 59025 • Maternity | $37 | $108 | $260 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $180 | $409 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $5,292 | $12,209 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $2,037 | $4,910 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $2,431 | $6,224 |
| External cephalic version CPT 59412 • Maternity | $97 | $153 | $191 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $1,798 | $4,656 |
| Postpartum care only CPT 59430 • Maternity | $85 | $390 | $1,019 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $5,823 | $13,595 |
| Cesarean delivery only CPT 59514 • Maternity | $162 | $2,070 | $5,566 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $711 | $2,917 | $7,555 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,250 | $3,381 | $4,649 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $210 | $627 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $53 | $255 | $726 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $94 | $371 | $917 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $34 | $155 | $442 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $180 | $503 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $15 | $34 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $98 | $208 | $409 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $132 | $235 | $455 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $91 | $157 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $85 | $144 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $124 | $207 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $111 | $203 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $122 | $218 | $307 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $149 | $269 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $109 | $190 | $328 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $88 | $138 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $137 | $226 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $153 | $232 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $47 | $69 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $327 | $795 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $130 | $230 | $318 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $127 | $195 | $320 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $728 | $1,611 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $131 | $205 | $312 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $88 | $150 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $119 | $200 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $83 | $104 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $109 | $213 |