| Strep A assay with optic observation CPT 87880 • Laboratory | $11 | $11 | $11 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $41 | $80 | $134 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $164 | $164 | $164 |
| Chorionic villus sampling CPT 59015 • Maternity | $41 | $97 | $144 |
| Fetal non-stress test CPT 59025 • Maternity | $25 | $38 | $49 |
| Insertion cervical dilator CPT 59200 • Maternity | $36 | $53 | $76 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $41 | $1,248 | $2,310 |
| Vaginal delivery only CPT 59409 • Maternity | $41 | $458 | $715 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $41 | $450 | $1,005 |
| External cephalic version CPT 59412 • Maternity | $41 | $73 | $93 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $474 | $665 | $760 |
| Postpartum care only CPT 59430 • Maternity | $101 | $138 | $157 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $41 | $555 | $1,577 |
| Cesarean delivery only CPT 59514 • Maternity | $41 | $528 | $811 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $41 | $707 | $1,218 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $41 | $912 | $2,100 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $70 | $110 | $129 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $41 | $75 | $144 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $85 | $126 | $189 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $29 | $49 | $76 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $71 | $88 | $98 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $14 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $115 | $139 | $165 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $122 | $160 | $172 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $48 | $67 | $76 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $40 | $70 | $85 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $73 | $101 | $121 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $66 | $99 | $132 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $116 | $130 | $151 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $132 | $152 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $159 | $169 | $182 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $68 | $80 | $91 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $113 | $143 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $118 | $130 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $37 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $41 | $107 | $151 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $95 | $173 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $112 | $112 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $132 | $251 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $46 | $247 | $347 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $71 | $87 | $99 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $109 | $132 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $73 | $86 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $40 | $80 | $100 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $114 | $115 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $73 | $114 | $137 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $74 | $145 | $181 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $180 | $257 | $295 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $37 | $54 | $85 |