| Blood typing Rh CPT 86901 • Laboratory | $2 | $4 | $6 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $11 | $17 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $21 | $41 | $52 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $21 | $30 | $41 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $43 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $4 | $14 | $18 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $75 | $118 | $134 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $127 | $231 | $304 |
| Chorionic villus sampling CPT 59015 • Maternity | $98 | $217 | $389 |
| Fetal non-stress test CPT 59025 • Maternity | $11 | $39 | $67 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $76 | $93 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,332 | $2,479 | $4,353 |
| Vaginal delivery only CPT 59409 • Maternity | $510 | $885 | $1,264 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $656 | $1,183 | $1,600 |
| External cephalic version CPT 59412 • Maternity | $65 | $149 | $304 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $521 | $934 | $1,587 |
| Postpartum care only CPT 59430 • Maternity | $129 | $195 | $245 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,478 | $2,469 | $3,000 |
| Cesarean delivery only CPT 59514 • Maternity | $576 | $1,097 | $1,569 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $799 | $1,305 | $1,896 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,402 | $2,329 | $3,547 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $31 | $139 | $316 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $31 | $181 | $475 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $108 | $175 | $238 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $20 | $76 | $99 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $58 | $119 | $240 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $7 | $12 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $77 | $137 | $176 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $86 | $151 | $206 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $43 | $63 | $73 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $40 | $61 | $81 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $57 | $88 | $104 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $55 | $84 | $118 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $76 | $113 | $144 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $66 | $114 | $140 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $89 | $121 | $153 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $38 | $61 | $73 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $94 | $108 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $64 | $100 | $115 |
| Group psychotherapy CPT 90853 • Mental Health | $15 | $30 | $48 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $182 | $364 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $73 | $192 | $388 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $83 | $162 | $266 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $36 | $209 | $357 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $319 | $733 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $86 | $115 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $37 | $100 | $188 |
| EMG needle each extremity complete CPT 95886 • Neurology | $31 | $62 | $99 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $25 | $68 | $107 |