| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $21 | $36 | $51 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $7 | $7 | $7 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $7 | $7 | $7 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $26 | $26 | $26 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $157 | $176 | $195 |
| Chorionic villus sampling CPT 59015 • Maternity | $102 | $102 | $102 |
| Fetal non-stress test CPT 59025 • Maternity | $26 | $36 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $14 | $59 | $104 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,893 | $1,893 | $1,893 |
| Vaginal delivery only CPT 59409 • Maternity | $415 | $599 | $784 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $354 | $695 | $1,036 |
| External cephalic version CPT 59412 • Maternity | $53 | $53 | $53 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $620 | $620 | $620 |
| Postpartum care only CPT 59430 • Maternity | $59 | $59 | $59 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,105 | $2,105 | $2,105 |
| Cesarean delivery only CPT 59514 • Maternity | $471 | $471 | $471 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $440 | $856 | $1,273 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,323 | $1,882 | $2,441 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $91 | $91 | $91 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $106 | $106 | $106 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $46 | $100 | $154 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $63 | $67 | $72 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $30 | $56 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $6 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $183 | $183 | $183 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $171 | $171 | $171 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $93 | $93 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $102 | $102 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $130 | $130 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $116 | $116 | $116 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $108 | $108 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $85 | $85 | $85 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $134 | $134 | $134 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $150 | $150 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $2 | $2 | $2 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $33 | $33 | $33 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $93 | $113 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $57 | $95 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $29 | $198 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $207 | $207 | $207 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $33 | $72 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $83 | $122 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $27 | $27 | $27 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $47 | $68 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $24 | $68 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $40 | $87 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $91 | $133 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $53 | $169 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $37 | $54 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $57 | $57 | $57 |