| Strep A assay with optic observation CPT 87880 • Laboratory | $14 | $21 | $27 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $30 | $30 | $30 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $227 | $227 | $227 |
| Fetal non-stress test CPT 59025 • Maternity | $20 | $37 | $53 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,890 | $1,890 | $1,890 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $609 | $1,189 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $30 | $30 | $30 |
| External cephalic version CPT 59412 • Maternity | $30 | $30 | $30 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $917 | $917 | $917 |
| Postpartum care only CPT 59430 • Maternity | $217 | $217 | $217 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $30 | $1,715 | $3,400 |
| Cesarean delivery only CPT 59514 • Maternity | $30 | $30 | $30 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $30 | $30 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $30 | $30 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $109 | $109 | $109 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $30 | $30 | $30 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $162 | $162 | $162 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $45 | $45 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $87 | $87 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $15 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $138 | $154 | $174 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $194 | $205 | $225 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $75 | $80 | $85 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $68 | $71 | $74 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $87 | $90 | $92 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $89 | $92 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $96 | $116 | $136 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $115 | $134 | $152 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $140 | $140 | $140 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $59 | $59 | $59 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $80 | $80 | $80 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $101 | $103 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $22 | $22 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $150 | $150 | $150 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $147 | $147 | $147 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $383 | $383 | $383 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $451 | $451 | $451 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $128 | $128 | $128 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $183 | $183 | $183 |
| EMG needle each extremity complete CPT 95886 • Neurology | $100 | $100 | $100 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $101 | $101 | $101 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $131 | $131 | $132 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $86 | $86 | $86 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $206 | $206 | $206 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $321 | $321 | $321 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $75 | $75 | $75 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $133 | $160 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $16 | $147 | $279 |