| Amniocentesis diagnostic CPT 59000 • Maternity | $99 | $206 | $348 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $191 | $334 | $507 |
| Chorionic villus sampling CPT 59015 • Maternity | $162 | $317 | $460 |
| Fetal non-stress test CPT 59025 • Maternity | $10 | $46 | $85 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $111 | $200 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $586 | $3,094 | $4,793 |
| Vaginal delivery only CPT 59409 • Maternity | $586 | $1,201 | $1,830 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $586 | $1,406 | $2,356 |
| External cephalic version CPT 59412 • Maternity | $91 | $140 | $232 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $885 | $1,879 |
| Postpartum care only CPT 59430 • Maternity | $118 | $294 | $466 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,200 | $3,720 | $5,299 |
| Cesarean delivery only CPT 59514 • Maternity | $851 | $1,354 | $1,800 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $964 | $1,744 | $2,860 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $586 | $3,104 | $5,024 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $124 | $205 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $60 | $220 | $315 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $224 | $401 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $76 | $120 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $113 | $211 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $20 | $35 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $116 | $206 | $344 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $276 | $398 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $113 | $178 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $75 | $109 | $182 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $67 | $145 | $222 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $139 | $231 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $101 | $219 | $363 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $156 | $273 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $231 | $369 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $107 | $177 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $117 | $181 | $243 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $189 | $288 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $50 | $80 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $53 | $153 | $333 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $92 | $220 | $448 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $183 | $279 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $348 | $815 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $440 | $833 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $70 | $112 | $148 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $24 | $160 | $403 |
| EMG needle each extremity complete CPT 95886 • Neurology | $51 | $114 | $220 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $108 | $124 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $170 | $302 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $124 | $162 | $183 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $190 | $235 | $301 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $297 | $489 | $759 |
| EEG monitoring continuous 24 hours CPT 95950 • Neurology | $854 | $854 | $854 |
| EEG monitoring continuous 24 hours with video CPT 95951 • Neurology | $5,680 | $5,680 | $5,680 |