| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $35 | $45 | $49 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $58 | $72 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $19 | $23 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $205 | $205 | $205 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $180 | $180 | $180 |
| Chorionic villus sampling CPT 59015 • Maternity | $118 | $118 | $118 |
| Fetal non-stress test CPT 59025 • Maternity | $48 | $59 | $64 |
| Insertion cervical dilator CPT 59200 • Maternity | $90 | $90 | $90 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,694 | $2,694 | $2,694 |
| Vaginal delivery only CPT 59409 • Maternity | $899 | $899 | $899 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $975 | $975 | $975 |
| External cephalic version CPT 59412 • Maternity | $161 | $161 | $161 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $931 | $931 | $931 |
| Postpartum care only CPT 59430 • Maternity | $231 | $231 | $231 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $3,050 | $3,362 | $3,517 |
| Cesarean delivery only CPT 59514 • Maternity | $885 | $1,160 | $1,416 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,209 | $1,209 | $1,209 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,278 | $2,278 | $2,278 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $79 | $130 | $156 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $79 | $146 | $180 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $152 | $209 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $76 | $97 | $107 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $55 | $100 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $10 | $10 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $175 | $175 | $175 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $133 | $133 | $133 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $97 | $97 | $97 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $105 | $105 | $105 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $84 | $84 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $114 | $114 | $114 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $113 | $113 | $113 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $181 | $181 | $181 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $66 | $66 | $66 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $110 | $110 | $110 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $106 | $106 | $106 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $25 | $25 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $58 | $124 | $192 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $200 | $200 | $200 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $252 | $252 | $252 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $65 | $367 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $414 | $596 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $70 | $70 | $70 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $86 | $86 | $86 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $75 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $76 | $76 | $76 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $49 | $49 | $49 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $80 | $80 | $80 |