| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $13 | $13 | $13 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $13 | $19 | $24 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $38 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $9 | $10 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $8 | $9 | $10 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $105 | $105 | $105 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $32 | $32 | $32 |
| Chorionic villus sampling CPT 59015 • Maternity | $105 | $105 | $105 |
| Fetal non-stress test CPT 59025 • Maternity | $23 | $26 | $29 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,300 | $2,300 | $2,300 |
| Vaginal delivery only CPT 59409 • Maternity | $647 | $647 | $647 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $32 | $32 | $32 |
| External cephalic version CPT 59412 • Maternity | $82 | $82 | $82 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $667 | $667 | $667 |
| Postpartum care only CPT 59430 • Maternity | $152 | $160 | $168 |
| Cesarean delivery only CPT 59514 • Maternity | $727 | $727 | $727 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $32 | $32 | $32 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $85 | $91 | $97 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $98 | $105 | $112 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $72 | $72 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $59 | $62 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $27 | $27 | $27 |
| Interactive complexity add-on CPT 90785 • Mental Health | $21 | $21 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $128 | $147 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $191 | $222 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $74 | $96 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $85 | $99 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $69 | $88 | $108 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $126 | $126 | $126 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $102 | $123 | $144 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $166 | $166 | $166 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $200 | $200 | $200 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $72 | $72 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $116 | $116 | $116 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $160 | $160 | $160 |
| Group psychotherapy CPT 90853 • Mental Health | $37 | $37 | $37 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $173 | $173 | $173 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $126 | $126 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $372 | $372 | $372 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $425 | $425 | $425 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $124 | $124 | $124 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $96 | $96 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $124 | $124 | $124 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $70 | $70 | $70 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $196 | $196 | $196 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $292 | $292 | $292 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $90 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $85 | $123 | $160 |