| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $16 | $27 | $37 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $49 | $57 | $72 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $9 | $20 | $36 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $169 | $283 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $324 | $473 |
| Chorionic villus sampling CPT 59015 • Maternity | $130 | $216 | $358 |
| Fetal non-stress test CPT 59025 • Maternity | $37 | $60 | $77 |
| Insertion cervical dilator CPT 59200 • Maternity | $44 | $92 | $179 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $3,063 | $3,813 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $1,007 | $1,254 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $1,097 | $1,415 |
| External cephalic version CPT 59412 • Maternity | $97 | $147 | $236 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $883 | $1,353 |
| Postpartum care only CPT 59430 • Maternity | $118 | $214 | $347 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $4,021 | $6,347 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $993 | $1,181 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $886 | $1,200 | $1,749 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,679 | $2,908 | $4,794 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $108 | $156 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $151 | $212 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $164 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $43 | $47 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $104 | $145 |
| Interactive complexity add-on CPT 90785 • Mental Health | $20 | $24 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $165 | $196 | $237 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $200 | $233 | $265 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $90 | $107 | $123 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $92 | $97 | $100 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $122 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $91 | $110 | $125 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $178 | $239 | $301 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $135 | $176 | $240 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $163 | $173 | $186 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $90 | $101 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $117 | $135 | $153 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $115 | $132 | $142 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $44 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $127 | $192 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $118 | $198 | $307 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $173 | $179 | $183 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $240 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $461 | $624 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $65 | $137 | $265 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $130 | $166 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $83 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $81 | $138 | $209 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $152 | $199 | $271 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $179 | $190 | $210 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $113 | $195 | $240 |