| Heterophile antibodies screen CPT 86308 • Laboratory | $4 | $9 | $13 |
| TB skin test intradermal CPT 86580 • Laboratory | $5 | $10 | $13 |
| Blood typing ABO CPT 86900 • Laboratory | $1 | $5 | $7 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $5 | $7 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $14 | $20 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $48 | $62 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $48 | $62 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $54 | $90 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $20 | $28 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $55 | $116 | $183 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $253 | $319 |
| Chorionic villus sampling CPT 59015 • Maternity | $30 | $130 | $242 |
| Fetal non-stress test CPT 59025 • Maternity | $30 | $51 | $71 |
| Insertion cervical dilator CPT 59200 • Maternity | $29 | $79 | $120 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,714 | $3,150 |
| Vaginal delivery only CPT 59409 • Maternity | $36 | $650 | $1,204 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $58 | $742 | $1,391 |
| External cephalic version CPT 59412 • Maternity | $97 | $123 | $162 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $816 | $1,520 |
| Postpartum care only CPT 59430 • Maternity | $85 | $198 | $392 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $2,898 | $3,530 |
| Cesarean delivery only CPT 59514 • Maternity | $36 | $831 | $1,424 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $58 | $956 | $1,675 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,390 | $2,478 | $3,420 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $114 | $215 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $53 | $101 | $233 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $94 | $171 | $271 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $80 | $133 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $85 | $144 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $6 | $9 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $75 | $148 | $285 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $132 | $188 | $249 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $71 | $94 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $65 | $113 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $55 | $92 | $154 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $97 | $143 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $193 | $304 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $147 | $208 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $109 | $216 | $310 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $101 | $161 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $55 | $97 | $145 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $55 | $114 | $171 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $50 | $84 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $75 | $159 | $250 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $82 | $200 | $304 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $95 | $158 | $214 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $220 | $421 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $260 | $470 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $75 | $111 |