| Blood typing Rh CPT 86901 • Laboratory | $1 | $4 | $8 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $10 | $18 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $17 | $41 | $77 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $28 | $47 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $51 | $75 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $17 | $31 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $52 | $154 | $268 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $189 | $277 | $454 |
| Chorionic villus sampling CPT 59015 • Maternity | $156 | $224 | $362 |
| Fetal non-stress test CPT 59025 • Maternity | $11 | $43 | $111 |
| Insertion cervical dilator CPT 59200 • Maternity | $42 | $121 | $299 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,074 | $3,045 | $5,503 |
| Vaginal delivery only CPT 59409 • Maternity | $749 | $1,097 | $1,819 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $691 | $1,328 | $2,464 |
| External cephalic version CPT 59412 • Maternity | $66 | $135 | $236 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $746 | $1,194 | $2,406 |
| Postpartum care only CPT 59430 • Maternity | $140 | $270 | $593 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,726 | $3,128 | $6,163 |
| Cesarean delivery only CPT 59514 • Maternity | $850 | $1,258 | $2,080 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,255 | $1,759 | $3,082 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,627 | $2,986 | $5,817 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $49 | $130 | $251 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $44 | $147 | $291 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $96 | $208 | $380 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $47 | $88 | $175 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $33 | $102 | $198 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $14 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $120 | $207 | $353 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $128 | $229 | $401 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $64 | $98 | $166 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $42 | $82 | $146 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $83 | $133 | $187 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $132 | $229 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $121 | $192 | $325 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $111 | $171 | $291 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $167 | $182 | $199 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $80 | $89 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $137 | $230 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $105 | $153 | $240 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $42 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $96 | $193 | $325 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $121 | $203 | $307 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $102 | $186 | $319 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $52 | $278 | $852 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $360 | $993 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $46 | $96 | $238 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $36 | $98 | $150 |
| EMG needle each extremity complete CPT 95886 • Neurology | $48 | $99 | $201 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $39 | $111 | $189 |