| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $5 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $17 | $26 | $35 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $26 | $35 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $40 | $49 | $59 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $17 | $26 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $111 | $127 | $142 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $229 | $255 | $282 |
| Chorionic villus sampling CPT 59015 • Maternity | $174 | $179 | $183 |
| Fetal non-stress test CPT 59025 • Maternity | $37 | $50 | $64 |
| Insertion cervical dilator CPT 59200 • Maternity | $63 | $72 | $82 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,885 | $2,501 | $2,932 |
| Vaginal delivery only CPT 59409 • Maternity | $639 | $846 | $1,133 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $843 | $1,165 | $1,456 |
| External cephalic version CPT 59412 • Maternity | $81 | $112 | $144 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $807 | $943 | $1,146 |
| Postpartum care only CPT 59430 • Maternity | $195 | $202 | $209 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,885 | $2,575 | $3,251 |
| Cesarean delivery only CPT 59514 • Maternity | $721 | $956 | $1,279 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,036 | $1,394 | $1,770 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,885 | $2,485 | $3,085 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $47 | $90 | $131 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $47 | $66 | $104 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $89 | $135 | $182 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $44 | $67 | $93 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $35 | $52 | $72 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $18 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $154 | $165 | $176 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $164 | $191 | $218 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $71 | $80 | $88 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $73 | $91 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $118 | $124 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $124 | $125 | $125 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $143 | $159 | $175 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $143 | $147 | $151 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $154 | $168 | $183 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $77 | $87 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $125 | $134 | $142 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $125 | $136 | $147 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $48 | $57 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $46 | $65 | $87 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $119 | $138 | $158 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $121 | $157 | $202 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $54 | $259 | $388 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $57 | $177 | $394 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $72 | $88 | $103 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $112 | $125 | $138 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $67 | $90 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $76 | $100 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $67 | $111 | $161 |