| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $24 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $41 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $14 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $57 | $114 | $188 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $273 | $318 |
| Chorionic villus sampling CPT 59015 • Maternity | $162 | $201 | $234 |
| Fetal non-stress test CPT 59025 • Maternity | $31 | $47 | $72 |
| Insertion cervical dilator CPT 59200 • Maternity | $47 | $70 | $107 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,835 | $3,156 |
| Vaginal delivery only CPT 59409 • Maternity | $639 | $866 | $1,237 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $711 | $1,032 | $1,578 |
| External cephalic version CPT 59412 • Maternity | $73 | $109 | $157 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $685 | $1,226 |
| Postpartum care only CPT 59430 • Maternity | $118 | $181 | $278 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,076 | $3,530 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $1,255 | $1,521 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,336 | $1,915 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,390 | $2,319 | $3,316 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $79 | $126 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $113 | $145 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $201 | $301 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $54 | $86 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $66 | $99 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $150 | $184 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $136 | $168 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $69 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $56 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $101 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $77 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $142 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $112 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $109 | $129 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $69 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $107 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $129 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $44 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $138 | $236 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $168 | $188 | $200 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $151 | $189 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $259 | $366 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $301 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $82 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $69 | $107 | $160 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $62 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $94 | $107 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $102 | $132 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $128 | $140 | $158 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $99 | $160 | $207 |