| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $23 | $29 | $35 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $23 | $29 | $35 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $5 | $28 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $5 | $11 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $96 | $321 | $461 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $245 | $543 | $757 |
| Chorionic villus sampling CPT 59015 • Maternity | $180 | $388 | $575 |
| Fetal non-stress test CPT 59025 • Maternity | $45 | $90 | $177 |
| Insertion cervical dilator CPT 59200 • Maternity | $92 | $197 | $263 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,850 | $5,074 | $7,748 |
| Vaginal delivery only CPT 59409 • Maternity | $929 | $2,156 | $3,041 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,038 | $2,600 | $3,877 |
| External cephalic version CPT 59412 • Maternity | $123 | $282 | $386 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $568 | $1,828 | $3,002 |
| Postpartum care only CPT 59430 • Maternity | $151 | $427 | $680 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,097 | $5,684 | $8,589 |
| Cesarean delivery only CPT 59514 • Maternity | $1,096 | $2,491 | $3,423 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,237 | $3,139 | $4,703 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,954 | $5,337 | $8,141 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $214 | $446 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $84 | $246 | $514 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $109 | $348 | $663 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $94 | $190 | $305 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $60 | $173 | $352 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $18 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $140 | $213 | $287 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $145 | $237 | $328 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $118 | $177 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $49 | $108 | $166 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $96 | $166 | $235 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $146 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $133 | $239 | $345 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $130 | $179 | $227 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $330 | $330 | $330 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $130 | $130 | $130 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $103 | $161 | $220 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $123 | $175 | $228 |
| Group psychotherapy CPT 90853 • Mental Health | $34 | $42 | $51 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $8 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $180 | $338 | $583 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $197 | $360 | $484 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $146 | $321 | $461 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $114 | $153 | $192 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $100 | $108 | $115 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $39 | $76 | $113 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $143 | $256 |
| EMG needle each extremity complete CPT 95886 • Neurology | $102 | $104 | $107 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $80 | $95 | $110 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $58 | $79 | $100 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $162 | $162 | $163 |