| TB skin test intradermal CPT 86580 • Laboratory | $3 | $6 | $8 |
| Blood typing ABO CPT 86900 • Laboratory | $1 | $4 | $8 |
| Blood typing Rh CPT 86901 • Laboratory | $1 | $4 | $8 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $6 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $44 | $90 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $44 | $90 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $13 | $39 | $56 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $11 | $14 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $70 | $100 | $146 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $220 | $283 |
| Chorionic villus sampling CPT 59015 • Maternity | $162 | $194 | $277 |
| Fetal non-stress test CPT 59025 • Maternity | $37 | $61 | $103 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $78 | $93 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,566 | $3,403 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $872 | $1,123 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,364 | $2,550 |
| External cephalic version CPT 59412 • Maternity | $91 | $100 | $108 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $979 | $2,171 |
| Postpartum care only CPT 59430 • Maternity | $118 | $204 | $324 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $2,312 | $2,388 |
| Cesarean delivery only CPT 59514 • Maternity | $204 | $728 | $961 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,515 | $2,550 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,250 | $2,621 | $3,575 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $46 | $80 | $143 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $54 | $87 | $159 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $88 | $150 | $209 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $71 | $110 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $74 | $108 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $14 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $133 | $150 | $182 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $137 | $159 | $190 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $69 | $83 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $72 | $94 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $98 | $121 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $93 | $103 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $148 | $166 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $117 | $130 | $152 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $141 | $156 | $182 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $64 | $75 | $91 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $115 | $143 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $108 | $123 | $143 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $40 | $50 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $83 | $116 | $166 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $140 | $159 | $173 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $154 | $232 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $302 | $418 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $62 | $229 | $373 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $72 | $99 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $89 | $123 | $169 |