| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $27 | $27 | $27 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $27 | $27 | $27 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $8 | $8 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $135 | $135 | $135 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $210 | $210 | $210 |
| Chorionic villus sampling CPT 59015 • Maternity | $161 | $161 | $161 |
| Fetal non-stress test CPT 59025 • Maternity | $49 | $49 | $49 |
| Insertion cervical dilator CPT 59200 • Maternity | $77 | $77 | $77 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,600 | $2,600 | $2,600 |
| Vaginal delivery only CPT 59409 • Maternity | $791 | $791 | $791 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $919 | $919 | $919 |
| External cephalic version CPT 59412 • Maternity | $106 | $106 | $106 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $804 | $804 | $804 |
| Postpartum care only CPT 59430 • Maternity | $144 | $144 | $144 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,600 | $2,600 | $2,600 |
| Cesarean delivery only CPT 59514 • Maternity | $937 | $937 | $937 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,107 | $1,107 | $1,107 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,600 | $2,600 | $2,600 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $110 | $110 | $110 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $123 | $123 | $123 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $172 | $172 | $172 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $76 | $76 | $76 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $84 | $84 | $84 |
| Interactive complexity add-on CPT 90785 • Mental Health | $17 | $17 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $203 | $203 | $203 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $228 | $228 | $228 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $80 | $80 | $80 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $102 | $102 | $102 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $170 | $170 | $170 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $135 | $135 | $135 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $163 | $163 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $109 | $109 | $109 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $114 | $114 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $31 | $31 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $164 | $164 | $164 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $158 | $158 | $158 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $135 | $135 | $135 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $252 | $252 | $252 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $271 | $271 | $271 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $90 | $90 | $90 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $130 | $130 | $130 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $129 | $129 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $155 | $155 | $155 |