| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $23 | $23 | $23 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $51 | $51 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $11 | $11 | $11 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $107 | $107 | $107 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $180 | $180 | $180 |
| Chorionic villus sampling CPT 59015 • Maternity | $140 | $140 | $140 |
| Fetal non-stress test CPT 59025 • Maternity | $44 | $44 | $44 |
| Insertion cervical dilator CPT 59200 • Maternity | $91 | $91 | $91 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,000 | $2,000 | $2,000 |
| Vaginal delivery only CPT 59409 • Maternity | $723 | $723 | $723 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $953 | $953 | $953 |
| External cephalic version CPT 59412 • Maternity | $92 | $92 | $92 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $920 | $920 | $920 |
| Postpartum care only CPT 59430 • Maternity | $234 | $234 | $234 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,100 | $2,100 | $2,100 |
| Cesarean delivery only CPT 59514 • Maternity | $817 | $817 | $817 |
| 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 | $2,100 | $2,100 | $2,100 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $104 | $104 | $104 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $119 | $119 | $119 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $150 | $150 | $150 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $72 | $72 | $72 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $82 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $3 | $3 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $162 | $162 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $146 | $146 | $146 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $75 | $75 | $75 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $108 | $108 | $108 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $118 | $118 | $118 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $124 | $124 | $124 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $136 | $136 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $146 | $146 | $146 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $73 | $73 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $108 | $108 | $108 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $108 | $108 | $108 |
| 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 | $136 | $136 | $136 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $138 | $138 | $138 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $139 | $139 | $139 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $350 | $350 | $350 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $420 | $420 | $420 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $110 | $110 | $110 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $159 | $159 |
| EMG needle each extremity complete CPT 95886 • Neurology | $94 | $94 | $94 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $132 | $132 | $132 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $174 | $174 | $174 |