| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $5 | $17 | $28 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $23 | $25 | $28 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $44 | $44 | $44 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $12 | $13 | $13 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $151 | $151 | $151 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $234 | $234 | $234 |
| Chorionic villus sampling CPT 59015 • Maternity | $176 | $176 | $176 |
| Fetal non-stress test CPT 59025 • Maternity | $35 | $41 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $89 | $89 | $89 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,964 | $1,964 | $1,964 |
| Vaginal delivery only CPT 59409 • Maternity | $885 | $885 | $885 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,017 | $1,017 | $1,017 |
| External cephalic version CPT 59412 • Maternity | $119 | $119 | $119 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $861 | $929 | $997 |
| Postpartum care only CPT 59430 • Maternity | $158 | $208 | $259 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,218 | $2,218 | $2,218 |
| Cesarean delivery only CPT 59514 • Maternity | $1,046 | $1,046 | $1,046 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,226 | $1,226 | $1,226 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,055 | $2,055 | $2,055 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $49 | $49 | $49 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $49 | $49 | $49 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $130 | $130 | $130 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $87 | $87 | $87 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $37 | $37 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $143 | $157 | $170 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $138 | $138 | $138 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $68 | $79 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $47 | $47 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $92 | $101 | $110 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $77 | $77 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $135 | $137 | $139 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $123 | $123 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $89 | $89 | $89 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $110 | $110 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $31 | $31 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $85 | $85 | $85 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $146 | $146 | $146 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $56 | $56 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $181 | $181 | $181 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $36 | $36 | $36 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $113 | $113 | $113 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $59 | $59 | $59 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $129 | $129 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $67 | $67 | $67 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $203 | $203 | $203 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $126 | $126 | $126 |