| Blood typing Rh CPT 86901 • Laboratory | $1 | $3 | $4 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $9 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $34 | $45 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $34 | $45 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $50 | $66 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $16 | $21 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $55 | $161 | $404 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $328 | $670 |
| Chorionic villus sampling CPT 59015 • Maternity | $134 | $238 | $508 |
| Fetal non-stress test CPT 59025 • Maternity | $28 | $48 | $97 |
| Insertion cervical dilator CPT 59200 • Maternity | $46 | $113 | $233 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,225 | $2,375 | $4,117 |
| Vaginal delivery only CPT 59409 • Maternity | $639 | $1,004 | $1,621 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $1,180 | $2,063 |
| External cephalic version CPT 59412 • Maternity | $58 | $149 | $341 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $1,275 | $2,659 |
| Postpartum care only CPT 59430 • Maternity | $85 | $279 | $601 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,425 | $2,598 | $4,549 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $1,281 | $1,821 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,465 | $2,496 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,225 | $2,848 | $4,313 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $53 | $95 | $192 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $39 | $83 | $132 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $258 | $474 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $60 | $85 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $71 | $99 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $17 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $98 | $200 | $327 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $205 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $89 | $162 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $81 | $166 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $120 | $216 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $117 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $122 | $185 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $160 | $278 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $195 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $91 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $134 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $145 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $38 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $79 | $149 | $259 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $82 | $218 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $128 | $202 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $70 | $246 | $544 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $40 | $187 | $645 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $43 | $98 | $146 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $134 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $94 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $114 | $233 |