| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $5 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $17 | $23 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $23 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $43 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $10 | $13 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $107 | $121 | $143 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $194 | $256 | $303 |
| Chorionic villus sampling CPT 59015 • Maternity | $98 | $142 | $176 |
| Fetal non-stress test CPT 59025 • Maternity | $23 | $39 | $49 |
| Insertion cervical dilator CPT 59200 • Maternity | $67 | $88 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,536 | $2,214 | $2,768 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $892 | $1,090 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,035 | $1,169 | $1,387 |
| External cephalic version CPT 59412 • Maternity | $99 | $113 | $138 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $842 | $959 | $1,039 |
| Postpartum care only CPT 59430 • Maternity | $133 | $211 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,578 | $2,942 | $3,190 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $1,006 | $1,225 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $850 | $1,266 | $1,678 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,441 | $3,058 | $3,835 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $52 | $121 | $208 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $105 | $124 | $149 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $105 | $150 | $191 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $71 | $102 | $143 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $98 | $109 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $13 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $146 | $177 | $203 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $158 | $176 | $200 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $73 | $82 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $74 | $84 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $97 | $111 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $94 | $105 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $145 | $162 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $125 | $132 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $151 | $168 | $178 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $81 | $86 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $115 | $122 | $133 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $130 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $42 | $69 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $47 | $92 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $76 | $128 | $176 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $130 | $140 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $249 | $381 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $65 | $317 | $456 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $63 | $83 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $94 | $146 | $184 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $104 | $113 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $60 | $70 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $54 | $80 | $111 |