| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $56 | $56 | $56 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $18 | $23 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $26 | $54 | $82 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $8 | $17 | $26 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $112 | $112 | $112 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $194 | $194 | $194 |
| Chorionic villus sampling CPT 59015 • Maternity | $151 | $151 | $151 |
| Fetal non-stress test CPT 59025 • Maternity | $46 | $46 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $103 | $103 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,338 | $2,338 | $2,338 |
| Vaginal delivery only CPT 59409 • Maternity | $783 | $783 | $783 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $987 | $1,011 | $1,035 |
| External cephalic version CPT 59412 • Maternity | $99 | $99 | $99 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $996 | $996 | $996 |
| Postpartum care only CPT 59430 • Maternity | $187 | $223 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,578 | $2,578 | $2,578 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $884 | $884 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,192 | $1,232 | $1,272 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,441 | $2,441 | $2,441 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $53 | $78 | $103 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $56 | $88 | $119 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $72 | $72 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $71 | $71 | $71 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $149 | $149 | $149 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $148 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $315 | $315 | $315 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $87 | $122 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $111 | $111 | $111 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $69 | $99 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $169 | $239 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $187 | $187 | $187 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $150 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $95 | $95 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $150 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $150 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $77 | $77 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $210 | $210 | $210 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $133 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $335 | $360 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $160 | $160 | $160 |
| EMG needle each extremity complete CPT 95886 • Neurology | $158 | $158 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $187 | $187 | $187 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |