| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $9 | $28 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $53 | $122 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $25 | $52 | $122 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $67 | $179 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $25 | $57 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $80 | $139 | $292 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $150 | $298 | $637 |
| Chorionic villus sampling CPT 59015 • Maternity | $106 | $232 | $414 |
| Fetal non-stress test CPT 59025 • Maternity | $10 | $56 | $98 |
| Insertion cervical dilator CPT 59200 • Maternity | $33 | $118 | $275 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $586 | $3,854 | $7,103 |
| Vaginal delivery only CPT 59409 • Maternity | $586 | $1,263 | $2,087 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $650 | $1,723 | $2,762 |
| External cephalic version CPT 59412 • Maternity | $97 | $171 | $325 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $113 | $1,466 | $3,270 |
| Postpartum care only CPT 59430 • Maternity | $147 | $388 | $664 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,660 | $4,346 | $6,890 |
| Cesarean delivery only CPT 59514 • Maternity | $890 | $1,576 | $2,356 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,241 | $2,038 | $3,390 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,557 | $4,173 | $6,522 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $68 | $165 | $321 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $47 | $174 | $312 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $85 | $221 | $481 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $28 | $112 | $179 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $31 | $109 | $202 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $26 | $49 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $98 | $258 | $496 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $113 | $301 | $638 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $55 | $127 | $247 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $108 | $203 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $90 | $155 | $326 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $39 | $144 | $286 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $110 | $269 | $480 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $127 | $212 | $379 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $131 | $229 | $461 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $101 | $228 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $180 | $314 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $195 | $326 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $50 | $99 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $8 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $49 | $157 | $320 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $91 | $220 | $434 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $95 | $260 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $95 | $578 | $1,206 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $95 | $654 | $1,398 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $48 | $149 | $358 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $24 | $169 | $383 |
| EMG needle each extremity complete CPT 95886 • Neurology | $51 | $118 | $233 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $120 | $287 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $98 | $199 | $357 |