| TB skin test intradermal CPT 86580 • Laboratory | $5 | $8 | $17 |
| Blood typing ABO CPT 86900 • Laboratory | $1 | $2 | $3 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $2 | $3 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $5 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $24 | $35 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $48 | $134 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $31 | $45 | $59 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $15 | $26 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $12 | $23 | $51 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $111 | $136 | $148 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $159 | $225 | $282 |
| Chorionic villus sampling CPT 59015 • Maternity | $122 | $163 | $183 |
| Fetal non-stress test CPT 59025 • Maternity | $14 | $44 | $64 |
| Insertion cervical dilator CPT 59200 • Maternity | $35 | $58 | $82 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,885 | $2,624 | $3,139 |
| Vaginal delivery only CPT 59409 • Maternity | $639 | $879 | $1,219 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $46 | $1,023 | $1,572 |
| External cephalic version CPT 59412 • Maternity | $81 | $97 | $144 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $651 | $858 | $1,146 |
| Postpartum care only CPT 59430 • Maternity | $110 | $181 | $209 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $40 | $2,262 | $3,543 |
| Cesarean delivery only CPT 59514 • Maternity | $720 | $862 | $1,279 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $46 | $1,045 | $1,770 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $40 | $1,691 | $3,085 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $47 | $92 | $131 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $47 | $79 | $104 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $89 | $138 | $182 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $44 | $60 | $93 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $35 | $54 | $73 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $29 | $61 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $109 | $142 | $176 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $107 | $163 | $218 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $71 | $88 | $122 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $85 | $142 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $98 | $111 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $124 | $137 | $163 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $143 | $259 | $551 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $143 | $228 | $476 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $154 | $161 | $183 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $81 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $89 | $134 | $178 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $80 | $119 | $147 |
| Group psychotherapy CPT 90853 • Mental Health | $19 | $37 | $57 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $46 | $67 | $92 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $103 | $144 | $195 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $103 | $139 | $202 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $54 | $244 | $388 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $57 | $268 | $415 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $72 | $102 | $131 |