| TB skin test intradermal CPT 86580 • Laboratory | $3 | $7 | $10 |
| Blood typing ABO CPT 86900 • Laboratory | $1 | $3 | $8 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $3 | $8 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $5 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $17 | $34 | $90 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $34 | $90 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $36 | $49 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $13 | $14 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $83 | $108 | $130 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $189 | $193 | $200 |
| Chorionic villus sampling CPT 59015 • Maternity | $123 | $145 | $162 |
| Fetal non-stress test CPT 59025 • Maternity | $14 | $33 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $42 | $74 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,703 | $2,196 | $2,375 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $876 | $1,485 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,137 | $1,575 |
| External cephalic version CPT 59412 • Maternity | $96 | $98 | $102 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $613 | $996 |
| Postpartum care only CPT 59430 • Maternity | $118 | $182 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,928 | $2,611 | $3,799 |
| Cesarean delivery only CPT 59514 • Maternity | $850 | $971 | $1,485 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,332 | $1,890 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,792 | $2,491 | $3,582 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $91 | $118 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $44 | $76 | $136 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $92 | $166 | $249 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $29 | $55 | $89 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $33 | $58 | $93 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $11 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $133 | $159 | $179 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $137 | $167 | $200 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $75 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $70 | $87 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $102 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $91 | $98 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $149 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $130 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $169 | $195 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $85 | $101 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $91 | $117 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $113 | $127 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $44 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $108 | $157 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $71 | $131 | $168 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $132 | $155 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $52 | $239 | $418 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $295 | $491 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $36 | $84 | $123 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $74 | $130 | $178 |