| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $9 | $9 | $9 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $111 | $111 | $111 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $189 | $189 | $189 |
| Chorionic villus sampling CPT 59015 • Maternity | $142 | $142 | $142 |
| Fetal non-stress test CPT 59025 • Maternity | $42 | $42 | $42 |
| Insertion cervical dilator CPT 59200 • Maternity | $63 | $63 | $63 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,500 | $2,500 | $2,500 |
| Vaginal delivery only CPT 59409 • Maternity | $754 | $754 | $754 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $962 | $962 | $962 |
| External cephalic version CPT 59412 • Maternity | $95 | $95 | $95 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $733 | $733 | $733 |
| Postpartum care only CPT 59430 • Maternity | $166 | $166 | $166 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,500 | $2,500 | $2,500 |
| Cesarean delivery only CPT 59514 • Maternity | $853 | $853 | $853 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,174 | $1,174 | $1,174 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,500 | $2,500 | $2,500 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $81 | $81 | $81 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $94 | $94 | $94 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $118 | $118 | $118 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $57 | $57 | $57 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $64 | $64 | $64 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $4 | $4 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $124 | $124 | $124 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $124 | $124 | $124 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $70 | $70 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $70 | $70 | $70 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $91 | $91 | $91 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $91 | $91 | $91 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $105 | $105 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $105 | $105 | $105 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $124 | $124 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $62 | $62 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $91 | $91 | $91 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $91 | $91 |
| Group psychotherapy CPT 90853 • Mental Health | $48 | $48 | $48 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $135 | $135 | $135 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $114 | $114 | $114 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $117 | $117 | $117 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $285 | $285 | $285 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $328 | $328 | $328 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $96 | $96 | $96 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $138 | $138 | $138 |
| EMG needle each extremity complete CPT 95886 • Neurology | $72 | $72 | $72 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $77 | $77 | $77 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $99 | $99 | $99 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $118 | $118 | $118 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $156 | $156 | $156 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $236 | $236 | $236 |