| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $17 | $26 | $34 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $58 | $72 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $12 | $14 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $111 | $135 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $164 | $178 | $191 |
| Chorionic villus sampling CPT 59015 • Maternity | $161 | $161 | $162 |
| Fetal non-stress test CPT 59025 • Maternity | $37 | $47 | $64 |
| Insertion cervical dilator CPT 59200 • Maternity | $36 | $46 | $55 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,536 | $1,786 | $2,200 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $1,049 | $1,623 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $684 | $1,038 | $1,623 |
| External cephalic version CPT 59412 • Maternity | $53 | $87 | $111 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $791 | $1,353 |
| Postpartum care only CPT 59430 • Maternity | $118 | $227 | $347 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,739 | $2,217 | $2,711 |
| Cesarean delivery only CPT 59514 • Maternity | $127 | $906 | $1,739 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,350 | $1,739 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,623 | $2,143 | $2,556 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $38 | $84 | $156 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $104 | $180 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $141 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $41 | $41 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $65 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $16 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $140 | $193 | $237 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $204 | $233 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $68 | $85 | $108 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $81 | $98 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $116 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $88 | $107 | $125 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $135 | $206 | $304 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $116 | $126 | $142 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $141 | $156 | $178 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $68 | $76 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $115 | $122 | $135 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $134 | $142 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $43 | $62 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $32 | $104 | $192 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $98 | $190 | $304 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $135 | $151 | $181 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $313 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $45 | $268 | $596 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $40 | $94 | $163 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $111 | $130 |
| EMG needle each extremity complete CPT 95886 • Neurology | $36 | $72 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $73 | $98 | $128 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $53 | $110 | $162 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $109 | $142 | $179 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $142 | $186 | $234 |