| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $6 | $8 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $20 | $27 | $33 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $27 | $33 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $46 | $61 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $15 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $57 | $134 | $193 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $284 | $318 |
| Chorionic villus sampling CPT 59015 • Maternity | $162 | $211 | $241 |
| Fetal non-stress test CPT 59025 • Maternity | $31 | $54 | $74 |
| Insertion cervical dilator CPT 59200 • Maternity | $47 | $80 | $110 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,937 | $3,242 |
| Vaginal delivery only CPT 59409 • Maternity | $639 | $967 | $1,271 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $1,179 | $1,621 |
| External cephalic version CPT 59412 • Maternity | $73 | $122 | $161 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $829 | $1,259 |
| Postpartum care only CPT 59430 • Maternity | $118 | $207 | $285 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,205 | $3,592 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $1,299 | $1,521 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,494 | $1,967 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,390 | $2,590 | $3,406 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $92 | $129 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $122 | $149 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $199 | $301 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $62 | $89 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $75 | $102 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $169 | $227 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $158 | $227 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $73 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $56 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $114 | $154 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $77 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $162 | $220 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $112 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $109 | $129 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $69 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $107 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $129 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $44 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $164 | $243 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $168 | $191 | $200 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $162 | $194 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $303 | $436 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $354 | $511 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $82 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $69 | $107 | $160 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $76 | $116 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $94 | $107 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $109 | $133 |