| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $22 | $22 | $22 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $10 | $16 | $22 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $104 | $104 | $104 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $173 | $173 | $173 |
| Fetal non-stress test CPT 59025 • Maternity | $45 | $49 | $53 |
| Insertion cervical dilator CPT 59200 • Maternity | $96 | $96 | $96 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,890 | $1,890 | $1,890 |
| Vaginal delivery only CPT 59409 • Maternity | $1,368 | $1,846 | $2,324 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,368 | $1,368 | $1,368 |
| External cephalic version CPT 59412 • Maternity | $88 | $88 | $88 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,388 | $1,388 | $1,388 |
| Postpartum care only CPT 59430 • Maternity | $362 | $362 | $362 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,318 | $2,318 | $2,318 |
| Cesarean delivery only CPT 59514 • Maternity | $2,836 | $2,836 | $2,836 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,587 | $1,587 | $1,587 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,368 | $1,368 | $1,368 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $162 | $162 | $162 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $187 | $187 | $187 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $75 | $75 | $75 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $27 | $31 | $34 |
| Interactive complexity add-on CPT 90785 • Mental Health | $20 | $20 | $20 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $161 | $200 | $239 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $180 | $224 | $267 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $104 | $104 | $104 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $95 | $95 | $95 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $121 | $121 | $121 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $131 | $131 | $131 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $115 | $115 | $115 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $141 | $141 | $141 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $69 | $69 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $72 | $72 | $72 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $100 | $100 | $100 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $23 | $23 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $270 | $270 | $270 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $127 | $138 | $150 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $187 | $187 | $187 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $523 | $523 | $523 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $614 | $614 | $614 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $103 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $144 | $144 | $144 |
| EMG needle each extremity complete CPT 95886 • Neurology | $138 | $138 | $138 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $126 | $126 | $126 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $121 | $139 | $156 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $157 | $157 | $157 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $245 | $245 | $245 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $270 | $270 | $270 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $129 | $129 | $129 |