| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $28 | $28 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $6 | $6 | $6 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $30 | $30 | $30 |
| Fetal non-stress test CPT 59025 • Maternity | $10 | $10 | $10 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $30 | $30 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $45 | $45 | $45 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $30 | $30 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $45 | $588 | $1,131 |
| External cephalic version CPT 59412 • Maternity | $112 | $112 | $112 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $879 | $879 | $879 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $30 | $30 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $38 | $45 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $87 | $120 | $154 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $38 | $45 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $95 | $99 | $102 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $10 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $145 | $168 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $176 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $71 | $82 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $72 | $87 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $80 | $105 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $83 | $99 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $141 | $141 | $141 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $115 | $121 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $147 | $147 | $147 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $83 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $88 | $119 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $129 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $46 | $46 | $46 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $367 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $476 | $476 | $476 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $101 | $117 | $134 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $141 | $151 | $161 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $98 | $107 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $101 | $118 | $136 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $195 | $215 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $314 | $342 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $71 | $71 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $45 | $104 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $45 | $45 | $45 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $30 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $55 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $30 | $30 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $38 | $45 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $30 | $30 |