| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $7 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $22 | $26 | $30 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $22 | $26 | $30 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $25 | $40 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $11 | $15 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $112 | $154 | $237 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $194 | $270 | $421 |
| Chorionic villus sampling CPT 59015 • Maternity | $151 | $206 | $316 |
| Fetal non-stress test CPT 59025 • Maternity | $38 | $50 | $60 |
| Insertion cervical dilator CPT 59200 • Maternity | $94 | $100 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,338 | $2,660 | $3,304 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $943 | $1,264 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,035 | $1,188 | $1,494 |
| External cephalic version CPT 59412 • Maternity | $99 | $124 | $174 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $996 | $1,058 | $1,181 |
| Postpartum care only CPT 59430 • Maternity | $216 | $244 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,578 | $3,979 | $5,826 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $1,112 | $1,569 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,272 | $1,480 | $1,896 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,441 | $2,810 | $3,547 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $103 | $198 | $325 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $119 | $201 | $379 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $164 | $238 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $71 | $78 | $86 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $83 | $128 | $202 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $20 | $35 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $292 | $410 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $164 | $261 | $440 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $113 | $186 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $60 | $94 | $171 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $85 | $150 | $246 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $128 | $217 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $242 | $372 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $113 | $153 | $184 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $120 | $399 | $688 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $182 | $344 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $123 | $166 | $234 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $94 | $167 | $244 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $67 | $131 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $157 | $226 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $131 | $161 | $221 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $148 | $178 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $93 | $376 | $718 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $94 | $602 | $981 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $83 | $121 | $203 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $133 | $176 | $280 |
| EMG needle each extremity complete CPT 95886 • Neurology | $59 | $112 | $206 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $67 | $99 | $152 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $81 | $161 | $271 |