| Influenza virus assay with direct optical CPT 87804 • Laboratory | $13 | $13 | $13 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $12 | $12 | $12 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $112 | $112 | $112 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $174 | $174 | $174 |
| Fetal non-stress test CPT 59025 • Maternity | $46 | $48 | $50 |
| Insertion cervical dilator CPT 59200 • Maternity | $103 | $116 | $128 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,338 | $2,338 | $2,338 |
| Vaginal delivery only CPT 59409 • Maternity | $753 | $768 | $783 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $997 | $997 | $997 |
| External cephalic version CPT 59412 • Maternity | $99 | $99 | $99 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $996 | $996 | $996 |
| Postpartum care only CPT 59430 • Maternity | $258 | $258 | $258 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,578 | $2,578 | $2,578 |
| Cesarean delivery only CPT 59514 • Maternity | $884 | $884 | $884 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,013 | $2,013 | $2,013 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $103 | $103 | $103 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $76 | $76 | $76 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $66 | $66 | $66 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $55 | $81 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $78 | $78 | $78 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $142 | $173 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $202 | $202 | $202 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $86 | $86 | $86 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $87 | $100 | $114 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $86 | $94 | $103 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $99 | $99 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $144 | $144 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $176 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $69 | $69 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $150 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $150 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $66 | $66 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $124 | $124 | $124 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $133 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $310 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $109 | $110 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $158 | $158 | $158 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $81 | $81 | $81 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $117 | $117 | $117 |