| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $11 | $11 | $11 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $11 | $11 | $12 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $118 | $118 | $118 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $45 | $45 | $45 |
| Chorionic villus sampling CPT 59015 • Maternity | $151 | $151 | $151 |
| Fetal non-stress test CPT 59025 • Maternity | $47 | $47 | $47 |
| Insertion cervical dilator CPT 59200 • Maternity | $88 | $88 | $88 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $45 | $45 | $45 |
| Vaginal delivery only CPT 59409 • Maternity | $782 | $782 | $782 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $45 | $527 | $1,009 |
| External cephalic version CPT 59412 • Maternity | $99 | $99 | $99 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $817 | $817 | $817 |
| Postpartum care only CPT 59430 • Maternity | $203 | $203 | $203 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $45 | $45 | $45 |
| Cesarean delivery only CPT 59514 • Maternity | $879 | $879 | $879 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $45 | $45 | $45 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $45 | $45 | $45 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $123 | $123 | $123 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $141 | $141 | $141 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $83 | $83 | $83 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $45 | $45 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $97 | $97 | $97 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $15 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $107 | $125 | $143 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $158 | $158 | $159 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $71 | $71 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $93 | $93 | $93 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $68 | $68 | $68 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $139 | $139 | $139 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $119 | $119 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $145 | $145 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $52 | $52 | $52 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $86 | $86 | $86 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $105 | $105 | $105 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $27 | $27 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $140 | $140 | $140 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $80 | $115 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $128 | $128 | $128 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $370 | $370 | $370 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $439 | $439 | $439 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $121 | $121 | $122 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $174 | $174 | $174 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $98 | $98 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $96 | $96 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $123 | $123 | $123 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $193 | $193 | $193 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $307 | $307 | $307 |