| Blood typing Rh CPT 86901 • Laboratory | $2 | $5 | $8 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $12 | $16 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $17 | $55 | $90 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $53 | $90 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $33 | $74 | $100 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $11 | $21 | $32 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $0 | $145 | $263 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $0 | $211 | $339 |
| Chorionic villus sampling CPT 59015 • Maternity | $1 | $179 | $296 |
| Fetal non-stress test CPT 59025 • Maternity | $1 | $51 | $86 |
| Insertion cervical dilator CPT 59200 • Maternity | $1 | $120 | $231 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1 | $2,188 | $4,141 |
| Vaginal delivery only CPT 59409 • Maternity | $1 | $798 | $1,352 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1 | $1,018 | $1,834 |
| External cephalic version CPT 59412 • Maternity | $1 | $110 | $174 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1 | $942 | $1,774 |
| Postpartum care only CPT 59430 • Maternity | $0 | $228 | $454 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $0 | $2,438 | $4,586 |
| Cesarean delivery only CPT 59514 • Maternity | $0 | $919 | $1,529 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1 | $1,249 | $2,269 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1 | $2,285 | $4,323 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $44 | $112 | $169 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $81 | $172 | $328 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $118 | $229 | $313 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $54 | $82 | $117 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $33 | $87 | $133 |
| Interactive complexity add-on CPT 90785 • Mental Health | $1 | $12 | $26 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $1 | $164 | $298 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $1 | $174 | $336 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $1 | $76 | $141 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $1 | $68 | $130 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $1 | $100 | $186 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $1 | $93 | $165 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $1 | $147 | $276 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $1 | $132 | $219 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $1 | $171 | $265 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $1 | $84 | $130 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $1 | $104 | $175 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $1 | $114 | $183 |
| Group psychotherapy CPT 90853 • Mental Health | $1 | $35 | $50 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $5 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $158 | $200 | $256 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $166 | $203 | $241 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $201 | $272 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $39 | $219 | $577 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $96 | $258 | $673 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $33 | $64 | $107 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $104 | $181 | $298 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $86 | $135 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $26 | $88 | $165 |