| Blood typing ABO CPT 86900 • Laboratory | $1 | $2 | $2 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $8 | $13 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $8 | $14 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $29 | $35 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $59 | $105 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $41 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $28 | $49 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $141 | $188 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $134 | $211 | $308 |
| Chorionic villus sampling CPT 59015 • Maternity | $162 | $201 | $234 |
| Fetal non-stress test CPT 59025 • Maternity | $29 | $46 | $72 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $64 | $107 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,323 | $2,226 | $3,156 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $991 | $1,237 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $1,032 | $1,578 |
| External cephalic version CPT 59412 • Maternity | $97 | $142 | $174 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $815 | $1,226 |
| Postpartum care only CPT 59430 • Maternity | $85 | $160 | $278 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,482 | $2,393 | $3,497 |
| Cesarean delivery only CPT 59514 • Maternity | $142 | $795 | $1,393 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $711 | $1,197 | $1,915 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,207 | $2,591 | $3,316 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $89 | $154 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $54 | $86 | $145 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $97 | $133 | $188 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $65 | $106 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $78 | $142 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $9 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $155 | $200 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $155 | $225 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $62 | $86 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $30 | $52 | $79 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $96 | $114 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $71 | $101 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $142 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $109 | $133 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $138 | $162 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $67 | $80 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $100 | $117 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $115 | $140 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $32 | $39 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $147 | $236 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $84 | $149 | $195 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $151 | $189 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $210 | $428 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $239 | $496 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $89 | $127 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $143 | $183 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $62 | $76 |