| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $25 | $40 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $11 | $15 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $30 | $134 | $237 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $194 | $308 | $421 |
| Chorionic villus sampling CPT 59015 • Maternity | $30 | $173 | $316 |
| Fetal non-stress test CPT 59025 • Maternity | $38 | $92 | $156 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $62 | $94 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $3,304 | $5,811 | $7,297 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $647 | $1,264 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $30 | $762 | $1,494 |
| External cephalic version CPT 59412 • Maternity | $30 | $102 | $174 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $996 | $1,088 | $1,181 |
| Postpartum care only CPT 59430 • Maternity | $216 | $605 | $808 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $3,532 | $6,398 | $8,074 |
| Cesarean delivery only CPT 59514 • Maternity | $30 | $799 | $1,569 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $963 | $1,896 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $1,789 | $3,547 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $132 | $302 | $370 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $133 | $293 | $408 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $153 | $205 | $238 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $71 | $80 | $86 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $93 | $159 | $280 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $25 | $48 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $353 | $568 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $164 | $392 | $655 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $165 | $282 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $60 | $140 | $264 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $85 | $218 | $373 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $189 | $335 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $343 | $548 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $113 | $264 | $443 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $120 | $411 | $688 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $210 | $344 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $123 | $228 | $349 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $94 | $227 | $362 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $79 | $131 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $10 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $128 | $226 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $231 | $442 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $156 | $178 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $93 | $663 | $1,293 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $94 | $894 | $1,507 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $83 | $220 | $378 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $160 | $280 |
| EMG needle each extremity complete CPT 95886 • Neurology | $59 | $172 | $316 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $67 | $102 | $152 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $81 | $200 | $376 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $183 | $225 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $115 | $306 | $588 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $130 | $550 | $955 |