| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $47 | $90 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $61 | $131 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $21 | $42 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $57 | $197 | $404 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $134 | $343 | $670 |
| Chorionic villus sampling CPT 59015 • Maternity | $87 | $265 | $508 |
| Fetal non-stress test CPT 59025 • Maternity | $31 | $58 | $97 |
| Insertion cervical dilator CPT 59200 • Maternity | $47 | $157 | $336 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,323 | $3,173 | $6,023 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $1,350 | $1,966 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $1,492 | $2,667 |
| External cephalic version CPT 59412 • Maternity | $73 | $176 | $341 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $1,443 | $2,659 |
| Postpartum care only CPT 59430 • Maternity | $85 | $352 | $661 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,830 | $6,670 |
| Cesarean delivery only CPT 59514 • Maternity | $142 | $1,216 | $2,224 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $711 | $1,794 | $3,301 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,200 | $3,451 | $6,287 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $149 | $300 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $54 | $151 | $346 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $311 | $474 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $67 | $98 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $77 | $112 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $20 | $37 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $253 | $434 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $260 | $488 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $115 | $205 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $102 | $189 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $156 | $271 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $142 | $240 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $230 | $401 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $192 | $319 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $248 | $386 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $120 | $189 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $167 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $178 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $52 | $73 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $195 | $372 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $168 | $267 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $142 | $249 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $356 | $868 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $140 | $263 | $496 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $135 | $284 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $194 | $396 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $134 | $240 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $121 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $162 | $282 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $74 | $224 | $345 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $70 | $204 | $444 |