| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $11 | $23 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $18 | $38 | $70 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $28 | $35 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $22 | $53 | $89 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $13 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $649 | $2,195 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $403 | $682 |
| Chorionic villus sampling CPT 59015 • Maternity | $162 | $718 | $2,195 |
| Fetal non-stress test CPT 59025 • Maternity | $36 | $186 | $682 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $235 | $682 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $3,370 | $5,919 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $2,746 | $7,926 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $2,354 | $5,919 |
| External cephalic version CPT 59412 • Maternity | $97 | $2,100 | $7,926 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $2,128 | $5,919 |
| Postpartum care only CPT 59430 • Maternity | $118 | $1,787 | $5,919 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,940 | $5,919 |
| Cesarean delivery only CPT 59514 • Maternity | $141 | $2,234 | $5,919 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $2,435 | $5,919 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,250 | $3,844 | $5,919 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $42 | $75 | $103 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $30 | $109 | $278 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $81 | $129 | $182 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $41 | $62 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $36 | $112 | $285 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $13 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $121 | $187 | $303 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $137 | $214 | $347 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $90 | $161 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $101 | $148 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $116 | $185 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $123 | $166 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $112 | $174 | $273 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $172 | $220 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $106 | $197 | $310 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $95 | $122 | $149 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $136 | $199 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $140 | $167 | $208 |
| Group psychotherapy CPT 90853 • Mental Health | $32 | $49 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $82 | $654 | $2,195 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $128 | $311 | $682 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $276 | $682 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $81 | $343 | $695 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $498 | $818 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $82 | $112 | $153 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $212 | $327 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $90 | $115 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $79 | $102 | $121 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $132 | $138 | $150 |