| Blood typing Rh CPT 86901 • Laboratory | $1 | $3 | $7 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $9 | $18 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $43 | $77 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $39 | $77 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $63 | $113 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $21 | $36 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $83 | $155 | $256 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $195 | $298 | $424 |
| Chorionic villus sampling CPT 59015 • Maternity | $134 | $213 | $340 |
| Fetal non-stress test CPT 59025 • Maternity | $30 | $48 | $64 |
| Insertion cervical dilator CPT 59200 • Maternity | $36 | $139 | $289 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,323 | $3,073 | $5,176 |
| Vaginal delivery only CPT 59409 • Maternity | $1,037 | $1,274 | $1,690 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,322 | $1,615 | $2,292 |
| External cephalic version CPT 59412 • Maternity | $100 | $156 | $218 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $154 | $1,188 | $2,217 |
| Postpartum care only CPT 59430 • Maternity | $85 | $301 | $568 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,585 | $3,626 | $5,732 |
| Cesarean delivery only CPT 59514 • Maternity | $1,181 | $1,518 | $1,911 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $711 | $1,736 | $2,837 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,487 | $3,760 | $5,403 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $138 | $258 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $45 | $175 | $297 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $92 | $208 | $391 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $29 | $60 | $80 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $54 | $86 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $19 | $32 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $98 | $228 | $373 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $182 | $271 | $419 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $103 | $176 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $92 | $162 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $98 | $146 | $233 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $96 | $133 | $206 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $100 | $182 | $345 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $127 | $176 | $274 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $211 | $331 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $97 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $111 | $148 | $219 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $143 | $229 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $39 | $63 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $167 | $320 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $91 | $182 | $302 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $184 | $301 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $463 | $866 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $452 | $889 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $123 | $244 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $76 | $175 | $340 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $80 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $43 | $62 | $82 |