| Blood typing Rh CPT 86901 • Laboratory | $3 | $5 | $10 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $7 | $11 | $17 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $25 | $42 | $54 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $29 | $40 | $54 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $48 | $70 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $11 | $16 | $23 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $83 | $141 | $177 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $228 | $336 | $553 |
| Chorionic villus sampling CPT 59015 • Maternity | $134 | $225 | $330 |
| Fetal non-stress test CPT 59025 • Maternity | $22 | $41 | $70 |
| Insertion cervical dilator CPT 59200 • Maternity | $48 | $93 | $141 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,698 | $2,494 | $3,316 |
| Vaginal delivery only CPT 59409 • Maternity | $908 | $1,163 | $1,485 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $975 | $1,258 | $1,575 |
| External cephalic version CPT 59412 • Maternity | $100 | $140 | $205 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $154 | $798 | $1,417 |
| Postpartum care only CPT 59430 • Maternity | $173 | $275 | $360 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,417 | $2,852 | $3,658 |
| Cesarean delivery only CPT 59514 • Maternity | $1,259 | $1,432 | $1,737 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,012 | $1,467 | $1,843 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,695 | $3,037 | $3,462 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $103 | $191 | $320 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $45 | $96 | $129 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $118 | $192 | $303 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $52 | $64 | $74 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $40 | $90 | $152 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $15 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $101 | $180 | $247 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $104 | $193 | $276 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $41 | $72 | $107 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $10 | $69 | $97 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $75 | $109 | $141 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $93 | $123 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $109 | $190 | $304 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $127 | $163 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $167 | $199 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $81 | $94 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $110 | $125 | $147 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $115 | $134 | $153 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $33 | $38 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $178 | $245 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $201 | $321 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $155 | $189 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $275 | $506 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $417 | $554 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $95 | $131 | $172 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $46 | $124 | $244 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $76 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $51 | $87 | $137 |