| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $3 | $3 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $14 | $14 | $14 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $14 | $14 | $14 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $31 | $31 | $31 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $14 | $14 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $10 | $10 | $10 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $80 | $80 | $80 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $118 | $118 | $118 |
| Chorionic villus sampling CPT 59015 • Maternity | $107 | $107 | $107 |
| Fetal non-stress test CPT 59025 • Maternity | $14 | $14 | $14 |
| Insertion cervical dilator CPT 59200 • Maternity | $88 | $88 | $88 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,470 | $1,470 | $1,470 |
| Vaginal delivery only CPT 59409 • Maternity | $476 | $476 | $476 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $645 | $645 | $645 |
| External cephalic version CPT 59412 • Maternity | $62 | $62 | $62 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $474 | $474 | $474 |
| Postpartum care only CPT 59430 • Maternity | $107 | $107 | $107 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,634 | $1,634 | $1,634 |
| Cesarean delivery only CPT 59514 • Maternity | $541 | $541 | $541 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $805 | $805 | $805 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,539 | $1,539 | $1,539 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $80 | $80 | $80 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $61 | $61 | $61 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $63 | $63 | $63 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $56 | $56 | $56 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $64 | $64 | $64 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $8 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $119 | $119 | $119 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $138 | $138 | $138 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $48 | $48 | $48 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $56 | $56 | $56 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $63 | $63 | $63 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $57 | $57 | $57 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $93 | $93 | $93 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $89 | $89 | $89 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $53 | $53 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $68 | $68 | $68 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $75 | $75 | $75 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $21 | $21 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $39 | $39 | $39 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $96 | $96 | $96 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $66 | $66 | $66 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $242 | $242 | $242 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $39 | $39 | $39 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $35 | $35 | $35 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $110 | $110 | $110 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $37 | $37 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $64 | $64 | $64 |