| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $42 | $62 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $45 | $64 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $17 | $21 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $117 | $137 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $114 | $180 | $236 |
| Chorionic villus sampling CPT 59015 • Maternity | $74 | $140 | $185 |
| Fetal non-stress test CPT 59025 • Maternity | $25 | $40 | $57 |
| Insertion cervical dilator CPT 59200 • Maternity | $40 | $82 | $153 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,785 | $2,320 | $2,974 |
| Vaginal delivery only CPT 59409 • Maternity | $543 | $980 | $1,676 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,061 | $1,415 |
| External cephalic version CPT 59412 • Maternity | $97 | $123 | $148 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $831 | $1,254 |
| Postpartum care only CPT 59430 • Maternity | $118 | $203 | $318 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $2,725 | $3,000 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $1,436 | $2,163 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $605 | $1,106 | $1,749 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,182 | $2,135 | $2,974 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $136 | $197 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $123 | $174 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $216 | $301 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $60 | $105 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $68 | $120 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $112 | $153 | $213 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $86 | $131 | $171 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $38 | $52 | $64 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $26 | $50 | $77 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $65 | $83 | $100 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $34 | $78 | $125 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $103 | $142 | $197 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $52 | $120 | $187 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $136 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $71 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $105 | $135 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $77 | $119 | $142 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $46 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $66 | $125 | $221 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $114 | $164 | $211 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $121 | $152 | $213 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $286 | $439 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $49 | $241 | $510 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $100 | $127 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $59 | $110 | $178 |
| EMG needle each extremity complete CPT 95886 • Neurology | $34 | $65 | $107 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $32 | $80 | $107 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $38 | $99 | $132 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $109 | $140 | $158 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $84 | $164 | $207 |