| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $28 | $28 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $28 | $28 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $17 | $17 | $17 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $30 | $30 | $30 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $194 | $194 | $194 |
| Chorionic villus sampling CPT 59015 • Maternity | $30 | $30 | $30 |
| Fetal non-stress test CPT 59025 • Maternity | $55 | $55 | $55 |
| Insertion cervical dilator CPT 59200 • Maternity | $142 | $142 | $142 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,262 | $2,262 | $2,262 |
| Vaginal delivery only CPT 59409 • Maternity | $716 | $716 | $716 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $973 | $973 | $973 |
| External cephalic version CPT 59412 • Maternity | $94 | $94 | $94 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,110 | $1,110 | $1,110 |
| Postpartum care only CPT 59430 • Maternity | $278 | $278 | $278 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,506 | $2,506 | $2,506 |
| Cesarean delivery only CPT 59514 • Maternity | $811 | $811 | $811 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,215 | $1,215 | $1,215 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,358 | $2,358 | $2,358 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $391 | $391 | $391 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $449 | $449 | $449 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $581 | $581 | $581 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $267 | $267 | $267 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $307 | $307 | $307 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $187 | $187 | $187 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $216 | $216 | $216 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $92 | $92 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $122 | $122 | $122 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $110 | $110 | $110 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $179 | $179 | $179 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $146 | $146 | $146 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $176 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $85 | $85 | $85 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $112 | $112 | $112 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $116 | $116 | $116 |
| Group psychotherapy CPT 90853 • Mental Health | $69 | $69 | $69 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $185 | $185 | $185 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $156 | $156 | $156 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $154 | $154 | $154 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $422 | $422 | $422 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $564 | $564 | $564 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $136 | $136 | $136 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $183 | $183 | $183 |
| EMG needle each extremity complete CPT 95886 • Neurology | $114 | $114 | $114 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $106 | $106 | $106 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $133 | $133 | $133 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $160 | $160 | $160 |