| Urine culture bacterial colony count CPT 87086 • Laboratory | $4 | $5 | $7 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $0 | $26 | $59 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $5 | $27 | $59 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $5 | $36 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $10 | $14 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $63 | $262 | $795 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $168 | $422 | $795 |
| Chorionic villus sampling CPT 59015 • Maternity | $110 | $346 | $795 |
| Fetal non-stress test CPT 59025 • Maternity | $17 | $84 | $184 |
| Insertion cervical dilator CPT 59200 • Maternity | $35 | $238 | $795 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $30 | $1,204 | $2,045 |
| Vaginal delivery only CPT 59409 • Maternity | $671 | $756 | $802 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $795 | $930 | $1,086 |
| External cephalic version CPT 59412 • Maternity | $30 | $73 | $103 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $873 | $1,702 | $3,193 |
| Postpartum care only CPT 59430 • Maternity | $150 | $375 | $795 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $30 | $1,334 | $2,264 |
| Cesarean delivery only CPT 59514 • Maternity | $135 | $804 | $1,411 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $795 | $923 | $1,125 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,134 | $3,622 | $4,898 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $59 | $142 | $249 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $56 | $136 | $286 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $75 | $261 | $619 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $26 | $36 | $51 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $30 | $80 | $195 |
| Interactive complexity add-on CPT 90785 • Mental Health | $12 | $29 | $57 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $125 | $278 | $535 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $163 | $318 | $592 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $75 | $81 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $63 | $135 | $268 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $79 | $183 | $347 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $80 | $175 | $339 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $135 | $152 | $166 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $226 | $446 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $114 | $278 | $543 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $63 | $136 | $260 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $86 | $194 | $382 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $84 | $98 | $120 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $52 | $104 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $9 | $17 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $95 | $338 | $795 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $73 | $265 | $795 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $48 | $282 | $795 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $560 | $1,338 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $48 | $697 | $1,586 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $43 | $183 | $443 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $65 | $260 | $635 |
| EMG needle each extremity complete CPT 95886 • Neurology | $38 | $150 | $360 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $163 | $354 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $39 | $179 | $450 |