| TB skin test intradermal CPT 86580 • Laboratory | $5 | $9 | $15 |
| Blood typing ABO CPT 86900 • Laboratory | $2 | $3 | $4 |
| Blood typing Rh CPT 86901 • Laboratory | $2 | $3 | $4 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $9 | $14 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $23 | $36 | $51 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $23 | $36 | $51 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $17 | $49 | $87 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $17 | $24 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $82 | $110 | $137 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $138 | $190 | $242 |
| Chorionic villus sampling CPT 59015 • Maternity | $145 | $166 | $187 |
| Fetal non-stress test CPT 59025 • Maternity | $44 | $52 | $63 |
| Insertion cervical dilator CPT 59200 • Maternity | $60 | $107 | $184 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $375 | $2,252 | $3,581 |
| Vaginal delivery only CPT 59409 • Maternity | $375 | $685 | $965 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $375 | $951 | $1,275 |
| External cephalic version CPT 59412 • Maternity | $93 | $1,380 | $3,924 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $551 | $974 | $1,220 |
| Postpartum care only CPT 59430 • Maternity | $188 | $249 | $313 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $261 | $2,008 | $2,964 |
| Cesarean delivery only CPT 59514 • Maternity | $261 | $767 | $1,094 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $261 | $1,031 | $1,571 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $435 | $2,108 | $3,089 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $120 | $241 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $68 | $115 | $186 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $96 | $154 | $199 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $89 | $120 | $167 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $45 | $91 | $190 |
| Interactive complexity add-on CPT 90785 • Mental Health | $7 | $11 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $163 | $193 | $216 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $168 | $218 | $261 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $86 | $87 | $88 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $57 | $83 | $113 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $112 | $123 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $94 | $99 | $103 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $164 | $174 | $191 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $133 | $140 | $150 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $117 | $133 | $162 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $58 | $69 | $80 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $79 | $100 | $110 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $109 | $122 | $140 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $33 | $38 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $166 | $251 | $348 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $194 | $261 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $86 | $168 | $256 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $69 | $219 | $362 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $92 | $282 | $430 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $55 | $69 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $89 | $113 | $147 |