| Strep A assay with optic observation CPT 87880 • Laboratory | $21 | $24 | $27 |
| Fetal non-stress test CPT 59025 • Maternity | $38 | $38 | $38 |
| Insertion cervical dilator CPT 59200 • Maternity | $88 | $88 | $88 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $3,190 | $4,506 | $5,822 |
| Vaginal delivery only CPT 59409 • Maternity | $973 | $1,462 | $1,952 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $2,578 | $2,578 | $2,578 |
| External cephalic version CPT 59412 • Maternity | $248 | $248 | $248 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,426 | $1,954 | $2,482 |
| Postpartum care only CPT 59430 • Maternity | $645 | $645 | $645 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $3,317 | $4,868 | $6,420 |
| Cesarean delivery only CPT 59514 • Maternity | $2,203 | $2,203 | $2,203 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,758 | $2,464 | $3,169 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $6,079 | $6,079 | $6,079 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $256 | $256 | $256 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $308 | $308 | $308 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $392 | $392 | $392 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $177 | $177 | $177 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $211 | $211 | $211 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $11 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $153 | $153 | $154 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $125 | $179 | $234 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $47 | $61 | $76 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $37 | $66 | $94 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $75 | $99 | $122 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $57 | $57 | $57 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $75 | $75 | $75 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $67 | $67 | $67 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $95 | $95 | $95 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $6 | $6 | $6 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $63 | $63 | $63 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $110 | $110 |
| Group psychotherapy CPT 90853 • Mental Health | $39 | $47 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $85 | $246 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $183 | $183 | $183 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $76 | $76 | $76 |
| EMG needle each extremity complete CPT 95886 • Neurology | $125 | $125 | $125 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $257 | $257 | $257 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $382 | $382 | $382 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $35 | $100 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $43 | $151 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $77 | $232 | $381 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $90 | $275 | $420 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $39 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $73 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $35 | $120 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $62 | $178 | $292 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $102 | $234 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $32 | $122 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $81 | $185 | $307 |