| Urine culture bacterial colony count CPT 87086 • Laboratory | $2 | $6 | $9 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $18 | $29 | $41 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $29 | $41 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $38 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $9 | $11 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $38 | $38 | $38 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $194 | $194 | $194 |
| Chorionic villus sampling CPT 59015 • Maternity | $38 | $38 | $38 |
| Fetal non-stress test CPT 59025 • Maternity | $29 | $36 | $44 |
| Insertion cervical dilator CPT 59200 • Maternity | $68 | $68 | $68 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,866 | $2,283 | $2,700 |
| Vaginal delivery only CPT 59409 • Maternity | $38 | $494 | $951 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $38 | $38 | $38 |
| External cephalic version CPT 59412 • Maternity | $85 | $85 | $85 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $610 | $648 | $686 |
| Postpartum care only CPT 59430 • Maternity | $142 | $241 | $339 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,866 | $2,807 | $3,749 |
| Cesarean delivery only CPT 59514 • Maternity | $38 | $690 | $1,342 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $38 | $38 | $38 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,866 | $1,866 | $1,866 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $85 | $115 | $145 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $73 | $120 | $167 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $82 | $82 | $82 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $20 | $60 | $101 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $22 | $46 | $70 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $101 | $133 | $165 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $134 | $150 | $166 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $45 | $52 | $60 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $65 | $85 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $77 | $93 | $110 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $64 | $90 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $87 | $116 | $145 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $138 | $138 | $138 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $165 | $165 | $165 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $95 | $95 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $150 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $72 | $101 | $130 |
| Group psychotherapy CPT 90853 • Mental Health | $77 | $77 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $96 | $118 | $140 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $147 | $147 | $147 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $108 | $108 | $108 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $90 | $205 | $320 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $358 | $358 | $358 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $98 | $98 | $98 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $141 | $141 | $141 |
| EMG needle each extremity complete CPT 95886 • Neurology | $95 | $118 | $141 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $94 | $110 | $126 |