| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $6 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $18 | $18 | $18 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $18 | $18 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $36 | $36 | $36 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $14 | $14 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $11 | $11 | $11 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $122 | $122 | $122 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $308 | $308 | $308 |
| Chorionic villus sampling CPT 59015 • Maternity | $233 | $233 | $233 |
| Fetal non-stress test CPT 59025 • Maternity | $69 | $69 | $69 |
| Insertion cervical dilator CPT 59200 • Maternity | $110 | $110 | $110 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,368 | $2,368 | $2,368 |
| Vaginal delivery only CPT 59409 • Maternity | $1,014 | $1,014 | $1,014 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,187 | $1,187 | $1,187 |
| External cephalic version CPT 59412 • Maternity | $156 | $156 | $156 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,232 | $1,232 | $1,232 |
| Postpartum care only CPT 59430 • Maternity | $209 | $209 | $209 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,681 | $2,681 | $2,681 |
| Cesarean delivery only CPT 59514 • Maternity | $1,204 | $1,204 | $1,204 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,436 | $1,436 | $1,436 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,493 | $2,493 | $2,493 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $49 | $123 | $196 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $90 | $147 | $203 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $94 | $119 | $145 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $32 | $58 | $84 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $91 | $145 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $8 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $256 | $256 | $256 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $206 | $206 | $206 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $106 | $106 | $106 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $71 | $71 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $125 | $125 | $125 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $201 | $201 | $201 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $185 | $185 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $283 | $283 | $283 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $147 | $147 | $147 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $136 | $136 | $136 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $174 | $174 | $174 |
| Group psychotherapy CPT 90853 • Mental Health | $51 | $51 | $51 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $8 | $8 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $121 | $121 | $121 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $246 | $246 | $246 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $193 | $193 | $193 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $86 | $86 | $86 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $328 | $328 | $328 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $78 | $142 | $174 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $192 | $211 | $220 |
| EMG needle each extremity complete CPT 95886 • Neurology | $139 | $143 | $147 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $131 | $140 | $159 |