| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $20 | $38 | $62 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $43 | $58 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $14 | $15 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $91 | $99 | $108 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $245 | $338 |
| Chorionic villus sampling CPT 59015 • Maternity | $87 | $169 | $259 |
| Fetal non-stress test CPT 59025 • Maternity | $15 | $32 | $45 |
| Insertion cervical dilator CPT 59200 • Maternity | $47 | $77 | $129 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,323 | $1,922 | $2,243 |
| Vaginal delivery only CPT 59409 • Maternity | $721 | $829 | $1,014 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $807 | $977 | $1,129 |
| External cephalic version CPT 59412 • Maternity | $73 | $88 | $97 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $499 | $956 |
| Postpartum care only CPT 59430 • Maternity | $118 | $196 | $324 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $2,735 | $3,530 |
| Cesarean delivery only CPT 59514 • Maternity | $850 | $905 | $1,014 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,105 | $1,222 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,250 | $2,635 | $3,311 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $84 | $118 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $91 | $136 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $162 | $195 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $34 | $52 | $82 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $64 | $94 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $147 | $176 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $132 | $155 | $195 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $67 | $86 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $56 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $91 | $114 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $77 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $138 | $171 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $112 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $132 | $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 | $82 | $127 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $40 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $49 | $87 | $124 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $167 | $200 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $95 | $117 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $273 | $410 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $338 | $481 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $128 | $195 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $152 | $280 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $94 | $153 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $100 | $156 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $147 | $201 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $54 | $151 | $240 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $169 | $231 | $315 |