| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $9 | $13 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $28 | $40 | $52 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $28 | $29 | $30 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $38 | $45 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $14 | $15 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $98 | $105 | $112 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $194 | $225 | $255 |
| Chorionic villus sampling CPT 59015 • Maternity | $151 | $234 | $316 |
| Fetal non-stress test CPT 59025 • Maternity | $27 | $43 | $59 |
| Insertion cervical dilator CPT 59200 • Maternity | $92 | $98 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,728 | $2,033 | $2,338 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $856 | $929 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,035 | $1,265 | $1,494 |
| External cephalic version CPT 59412 • Maternity | $99 | $138 | $177 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $500 | $748 | $996 |
| Postpartum care only CPT 59430 • Maternity | $216 | $237 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,728 | $2,153 | $2,578 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $1,226 | $1,569 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,272 | $1,282 | $1,292 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,199 | $2,320 | $2,441 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $45 | $74 | $103 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $76 | $104 | $133 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $153 | $173 | $192 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $43 | $43 | $43 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $46 | $48 | $49 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $6 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $166 | $170 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $162 | $163 | $164 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $74 | $78 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $76 | $87 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $89 | $109 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $74 | $86 | $98 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $144 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $120 | $132 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $157 | $167 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $76 | $85 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $124 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $126 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $51 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $158 | $192 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $131 | $158 | $185 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $156 | $178 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $55 | $182 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $71 | $250 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $77 | $94 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $37 | $98 | $160 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $56 | $59 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $45 | $52 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $118 | $126 |