| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $29 | $100 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $16 | $44 | $100 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $16 | $44 | $100 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $49 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $6 | $11 | $14 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $125 | $149 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $278 | $473 |
| Chorionic villus sampling CPT 59015 • Maternity | $130 | $158 | $187 |
| Fetal non-stress test CPT 59025 • Maternity | $37 | $54 | $77 |
| Insertion cervical dilator CPT 59200 • Maternity | $44 | $64 | $85 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,829 | $3,813 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $949 | $1,254 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,018 | $1,255 |
| External cephalic version CPT 59412 • Maternity | $97 | $108 | $125 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $755 | $1,246 |
| Postpartum care only CPT 59430 • Maternity | $118 | $165 | $219 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,614 | $6,347 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $966 | $1,111 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $886 | $1,126 | $1,530 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,679 | $2,151 | $2,523 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $82 | $111 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $39 | $105 | $212 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $141 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $49 | $65 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $73 | $145 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $14 | $20 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $133 | $152 | $165 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $137 | $185 | $265 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $83 | $123 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $77 | $100 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $110 | $141 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $98 | $137 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $169 | $238 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $115 | $133 | $158 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $158 | $170 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $66 | $82 | $101 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $101 | $126 | $153 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $106 | $123 | $140 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $42 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $128 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $118 | $146 | $168 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $143 | $173 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $50 | $125 | $249 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $40 | $219 | $624 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $43 | $74 | $107 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $137 | $166 |
| EMG needle each extremity complete CPT 95886 • Neurology | $38 | $60 | $79 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $81 | $88 | $107 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $42 | $113 | $175 |