| Urine culture bacterial colony count CPT 87086 • Laboratory | $5 | $5 | $5 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $21 | $21 | $21 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $21 | $21 | $21 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $22 | $22 | $22 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $14 | $14 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $7 | $7 | $7 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $157 | $157 | $157 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $248 | $248 | $248 |
| Chorionic villus sampling CPT 59015 • Maternity | $183 | $183 | $183 |
| Fetal non-stress test CPT 59025 • Maternity | $48 | $48 | $48 |
| Insertion cervical dilator CPT 59200 • Maternity | $92 | $92 | $92 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,792 | $1,792 | $1,792 |
| Vaginal delivery only CPT 59409 • Maternity | $899 | $899 | $899 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,005 | $1,005 | $1,005 |
| External cephalic version CPT 59412 • Maternity | $125 | $125 | $125 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $759 | $759 | $759 |
| Postpartum care only CPT 59430 • Maternity | $165 | $165 | $165 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,030 | $2,030 | $2,030 |
| Cesarean delivery only CPT 59514 • Maternity | $1,062 | $1,062 | $1,062 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,198 | $1,198 | $1,198 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,892 | $1,892 | $1,892 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $56 | $56 | $56 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $56 | $56 | $56 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $110 | $110 | $110 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $94 | $94 | $94 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $42 | $42 | $42 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $6 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $177 | $177 | $177 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $148 | $148 | $148 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $74 | $74 | $74 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $49 | $49 | $49 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $96 | $96 | $96 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $80 | $80 | $80 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $140 | $140 | $140 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $129 | $129 | $129 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $195 | $195 | $195 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $101 | $101 | $101 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $102 | $102 | $102 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $124 | $124 | $124 |
| Group psychotherapy CPT 90853 • Mental Health | $34 | $34 | $34 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $151 | $151 | $151 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $168 | $168 | $168 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $124 | $124 | $124 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $106 | $106 | $106 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $127 | $127 | $127 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $40 | $40 | $40 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $122 | $122 | $122 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $45 | $45 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $48 | $48 | $48 |