| Blood typing ABO CPT 86900 • Laboratory | $2 | $3 | $6 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $3 | $6 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $10 | $17 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $17 | $32 | $44 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $32 | $44 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $40 | $55 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $11 | $16 | $25 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $80 | $127 | $194 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $136 | $195 | $251 |
| Chorionic villus sampling CPT 59015 • Maternity | $107 | $167 | $259 |
| Fetal non-stress test CPT 59025 • Maternity | $33 | $44 | $58 |
| Insertion cervical dilator CPT 59200 • Maternity | $69 | $92 | $133 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,642 | $2,942 | $6,135 |
| Vaginal delivery only CPT 59409 • Maternity | $547 | $781 | $1,011 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $724 | $1,179 | $2,043 |
| External cephalic version CPT 59412 • Maternity | $70 | $143 | $304 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $617 | $1,237 | $2,380 |
| Postpartum care only CPT 59430 • Maternity | $179 | $270 | $383 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,811 | $2,802 | $4,522 |
| Cesarean delivery only CPT 59514 • Maternity | $618 | $1,058 | $1,805 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $891 | $1,692 | $3,713 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,715 | $2,239 | $2,702 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $50 | $111 | $221 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $95 | $149 | $257 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $118 | $178 | $328 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $92 | $236 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $38 | $87 | $178 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $9 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $121 | $146 | $193 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $135 | $156 | $215 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $53 | $78 | $119 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $48 | $61 | $81 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $69 | $95 | $110 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $61 | $87 | $118 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $102 | $139 | $190 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $80 | $116 | $140 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $97 | $127 | $146 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $48 | $63 | $73 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $66 | $91 | $108 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $69 | $100 | $119 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $30 | $48 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $66 | $95 | $132 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $94 | $157 | $231 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $95 | $167 | $266 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $226 | $388 | $639 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $54 | $298 | $641 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $51 | $85 | $115 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $109 | $139 | $167 |
| EMG needle each extremity complete CPT 95886 • Neurology | $39 | $70 | $109 |