| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $31 | $45 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $54 | $59 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $14 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $141 | $204 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $152 | $227 | $338 |
| Chorionic villus sampling CPT 59015 • Maternity | $158 | $193 | $259 |
| Fetal non-stress test CPT 59025 • Maternity | $20 | $45 | $79 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $83 | $129 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,876 | $3,513 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $1,089 | $1,360 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,122 | $1,742 |
| External cephalic version CPT 59412 • Maternity | $97 | $130 | $171 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $985 | $1,536 |
| Postpartum care only CPT 59430 • Maternity | $118 | $214 | $324 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,649 | $4,860 |
| Cesarean delivery only CPT 59514 • Maternity | $685 | $1,022 | $1,530 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,364 | $2,113 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,925 | $2,618 | $3,681 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $113 | $174 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $58 | $93 | $162 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $200 | $271 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $60 | $80 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $109 | $226 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $9 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $133 | $172 | $210 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $137 | $195 | $249 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $82 | $110 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $78 | $113 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $117 | $147 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $109 | $143 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $138 | $157 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $146 | $188 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $178 | $204 | $229 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $86 | $90 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $115 | $121 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $139 | $158 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $40 | $50 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $7 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $143 | $247 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $168 | $189 | $223 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $179 | $218 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $67 | $263 | $579 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $441 | $680 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $49 | $108 | $195 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $176 | $280 |
| EMG needle each extremity complete CPT 95886 • Neurology | $43 | $83 | $153 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $103 | $156 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $77 | $137 | $201 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $93 | $164 | $240 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $123 | $215 | $315 |