| Urine culture bacterial colony count CPT 87086 • Laboratory | $6 | $6 | $6 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $27 | $27 | $27 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $38 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $12 | $12 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $6 | $6 | $6 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $104 | $104 | $104 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $173 | $173 | $174 |
| Chorionic villus sampling CPT 59015 • Maternity | $113 | $113 | $113 |
| Fetal non-stress test CPT 59025 • Maternity | $18 | $31 | $44 |
| Insertion cervical dilator CPT 59200 • Maternity | $118 | $118 | $118 |
| Vaginal delivery only CPT 59409 • Maternity | $691 | $691 | $691 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $937 | $937 | $938 |
| External cephalic version CPT 59412 • Maternity | $89 | $89 | $89 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $906 | $906 | $906 |
| Postpartum care only CPT 59430 • Maternity | $232 | $232 | $232 |
| Cesarean delivery only CPT 59514 • Maternity | $781 | $781 | $781 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,160 | $1,160 | $1,161 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,890 | $1,890 | $1,890 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $122 | $122 | $122 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $141 | $141 | $141 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $187 | $187 | $187 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $85 | $85 | $85 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $60 | $78 | $97 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $14 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $127 | $148 | $169 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $190 | $190 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $80 | $80 | $80 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $73 | $73 | $74 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $79 | $92 | $106 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $79 | $86 | $94 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $101 | $101 | $101 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $124 | $124 | $124 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $150 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $73 | $74 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $84 | $92 | $100 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $103 | $103 | $104 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $28 | $28 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $143 | $143 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $136 | $136 | $136 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $135 | $135 | $135 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $436 | $436 | $437 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $509 | $509 | $509 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $123 | $123 | $123 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $172 | $172 | $172 |
| EMG needle each extremity complete CPT 95886 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $98 | $98 | $98 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $122 | $122 | $122 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $147 | $147 | $147 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $192 | $192 | $192 |