| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $3 | $3 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $15 | $15 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $15 | $15 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $31 | $31 | $31 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $10 | $10 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $10 | $10 | $10 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $101 | $101 | $101 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $147 | $147 | $147 |
| Chorionic villus sampling CPT 59015 • Maternity | $134 | $134 | $134 |
| Fetal non-stress test CPT 59025 • Maternity | $24 | $24 | $24 |
| Insertion cervical dilator CPT 59200 • Maternity | $111 | $111 | $111 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,200 | $2,200 |
| Vaginal delivery only CPT 59409 • Maternity | $587 | $587 | $587 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $796 | $796 | $796 |
| External cephalic version CPT 59412 • Maternity | $77 | $77 | $77 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $584 | $584 | $584 |
| Postpartum care only CPT 59430 • Maternity | $219 | $219 | $219 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $2,200 | $2,200 |
| Cesarean delivery only CPT 59514 • Maternity | $669 | $669 | $669 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,000 | $1,000 | $1,000 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,200 | $2,200 | $2,200 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $100 | $100 | $100 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $39 | $39 | $39 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $74 | $74 | $74 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $70 | $70 | $70 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $80 | $80 | $80 |
| Interactive complexity add-on CPT 90785 • Mental Health | $12 | $12 | $12 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $141 | $141 | $141 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $165 | $165 | $165 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $55 | $55 | $55 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $93 | $93 | $93 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $136 | $136 | $136 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $88 | $88 | $88 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $130 | $130 | $130 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $50 | $50 | $50 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $85 | $85 | $85 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $82 | $82 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $25 | $25 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $142 | $142 | $142 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $91 | $91 | $91 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $83 | $83 | $83 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $315 | $315 | $315 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $47 | $47 | $47 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $60 | $60 | $60 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $71 | $71 | $71 |
| EMG needle each extremity complete CPT 95886 • Neurology | $48 | $48 | $48 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $44 | $44 | $44 |