| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $49 | $86 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $20 | $61 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $8 | $12 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $79 | $215 | $443 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $30 | $351 | $734 |
| Chorionic villus sampling CPT 59015 • Maternity | $101 | $298 | $587 |
| Fetal non-stress test CPT 59025 • Maternity | $10 | $49 | $83 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $120 | $275 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $32 | $3,605 | $8,954 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $1,242 | $2,918 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $586 | $1,704 | $3,958 |
| External cephalic version CPT 59412 • Maternity | $61 | $199 | $376 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $200 | $1,870 | $3,833 |
| Postpartum care only CPT 59430 • Maternity | $92 | $423 | $991 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $32 | $3,979 | $9,925 |
| Cesarean delivery only CPT 59514 • Maternity | $535 | $1,819 | $3,300 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $2,189 | $4,904 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $32 | $4,173 | $9,354 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $113 | $199 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $53 | $178 | $428 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $94 | $228 | $676 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $97 | $232 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $84 | $121 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $24 | $55 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $275 | $645 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $335 | $725 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $136 | $293 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $30 | $129 | $269 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $172 | $386 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $161 | $340 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $101 | $298 | $569 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $193 | $451 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $268 | $548 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $119 | $271 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $169 | $363 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $191 | $381 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $51 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $9 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $63 | $257 | $554 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $234 | $522 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $273 | $519 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $69 | $530 | $1,334 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $169 | $614 | $1,270 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $121 | $204 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $69 | $257 | $608 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $96 | $173 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $120 | $299 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $132 | $334 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $81 | $166 | $448 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $169 | $258 | $665 |