| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $10 | $20 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $48 | $89 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $50 | $89 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $61 | $95 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $20 | $36 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $16 | $16 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $66 | $182 | $374 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $164 | $318 | $546 |
| Chorionic villus sampling CPT 59015 • Maternity | $134 | $363 | $893 |
| Fetal non-stress test CPT 59025 • Maternity | $19 | $73 | $133 |
| Insertion cervical dilator CPT 59200 • Maternity | $58 | $130 | $288 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $586 | $4,108 | $5,875 |
| Vaginal delivery only CPT 59409 • Maternity | $586 | $1,158 | $1,935 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $886 | $2,026 | $4,055 |
| External cephalic version CPT 59412 • Maternity | $84 | $186 | $289 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $154 | $1,373 | $2,917 |
| Postpartum care only CPT 59430 • Maternity | $114 | $377 | $723 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,973 | $5,076 | $6,945 |
| Cesarean delivery only CPT 59514 • Maternity | $254 | $1,593 | $3,700 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,124 | $2,781 | $6,865 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $586 | $3,867 | $6,147 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $62 | $146 | $284 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $39 | $174 | $329 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $84 | $260 | $556 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $29 | $100 | $197 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $136 | $224 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $27 | $42 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $284 | $433 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $154 | $305 | $557 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $63 | $112 | $215 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $117 | $227 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $88 | $152 | $285 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $80 | $161 | $291 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $133 | $267 | $419 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $94 | $204 | $379 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $269 | $455 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $66 | $124 | $218 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $85 | $164 | $273 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $88 | $187 | $365 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $51 | $90 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $64 | $200 | $421 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $265 | $433 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $91 | $216 | $431 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $40 | $353 | $973 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $552 | $1,062 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $54 | $173 | $368 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $70 | $250 | $531 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $119 | $228 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $34 | $136 | $294 |