| TB skin test intradermal CPT 86580 • Laboratory | $5 | $13 | $18 |
| Blood typing ABO CPT 86900 • Laboratory | $2 | $5 | $7 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $4 | $6 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $8 | $14 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $47 | $78 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $36 | $62 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $46 | $71 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $18 | $27 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $4 | $83 | $128 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $6 | $124 | $191 |
| Chorionic villus sampling CPT 59015 • Maternity | $5 | $110 | $162 |
| Fetal non-stress test CPT 59025 • Maternity | $33 | $46 | $69 |
| Insertion cervical dilator CPT 59200 • Maternity | $48 | $67 | $114 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $75 | $1,854 | $2,479 |
| Vaginal delivery only CPT 59409 • Maternity | $25 | $928 | $1,938 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $33 | $1,116 | $2,410 |
| External cephalic version CPT 59412 • Maternity | $3 | $72 | $103 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $32 | $577 | $1,497 |
| Postpartum care only CPT 59430 • Maternity | $8 | $179 | $286 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $83 | $1,990 | $2,733 |
| Cesarean delivery only CPT 59514 • Maternity | $28 | $663 | $1,370 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $41 | $1,009 | $1,546 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $79 | $1,817 | $2,429 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $38 | $52 | $66 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $151 | $321 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $6 | $162 | $349 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $25 | $68 | $128 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $89 | $152 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $13 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $5 | $112 | $162 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $6 | $151 | $278 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $79 | $107 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $30 | $60 | $97 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $3 | $89 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $3 | $84 | $133 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $5 | $109 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $3 | $91 | $165 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $5 | $110 | $201 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $77 | $98 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $3 | $86 | $135 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $3 | $103 | $141 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $34 | $39 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $106 | $132 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $4 | $172 | $304 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $4 | $102 | $142 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $62 | $147 | $360 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $78 | $337 | $606 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $87 | $125 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $5 | $102 | $178 |