| Strep A assay with optic observation CPT 87880 • Laboratory | $16 | $16 | $16 |
| Amniocentesis diagnostic CPT 59000 • Maternity | $137 | $137 | $137 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $242 | $242 | $242 |
| Chorionic villus sampling CPT 59015 • Maternity | $187 | $187 | $187 |
| Fetal non-stress test CPT 59025 • Maternity | $57 | $57 | $57 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,800 | $2,800 | $2,800 |
| Vaginal delivery only CPT 59409 • Maternity | $965 | $965 | $965 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,275 | $1,275 | $1,275 |
| External cephalic version CPT 59412 • Maternity | $123 | $123 | $123 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,220 | $1,220 | $1,220 |
| Postpartum care only CPT 59430 • Maternity | $313 | $313 | $313 |
| Cesarean delivery only CPT 59514 • Maternity | $1,094 | $1,094 | $1,094 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,571 | $1,571 | $1,571 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,800 | $2,800 | $2,800 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $55 | $55 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $99 | $99 | $99 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $96 | $96 | $96 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $37 | $37 | $37 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $106 | $106 | $106 |
| Interactive complexity add-on CPT 90785 • Mental Health | $17 | $17 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $170 | $185 | $201 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $225 | $225 | $225 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $86 | $86 | $86 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $79 | $79 | $79 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $86 | $86 | $86 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $77 | $77 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $126 | $126 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $133 | $133 | $133 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $162 | $162 | $162 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $61 | $61 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $82 | $82 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $115 | $115 | $115 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $27 | $27 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $166 | $166 | $166 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $172 | $172 | $172 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $362 | $362 | $362 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $430 | $430 | $430 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $69 | $98 | $128 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $184 | $184 | $184 |
| EMG needle each extremity complete CPT 95886 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $41 | $41 | $41 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $127 | $127 | $128 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $153 | $153 | $153 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $121 | $121 | $121 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $215 | $215 | $215 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $73 | $73 | $73 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $114 | $114 | $114 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $144 | $144 | $144 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $168 | $179 | $191 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $19 | $19 |