| Fetal non-stress test CPT 59025 • Maternity | $27 | $37 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $67 | $103 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,861 | $2,100 | $2,338 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $236 | $649 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $30 | $30 | $30 |
| External cephalic version CPT 59412 • Maternity | $99 | $99 | $99 |
| Postpartum care only CPT 59430 • Maternity | $216 | $216 | $216 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $30 | $1,121 | $2,212 |
| Cesarean delivery only CPT 59514 • Maternity | $30 | $30 | $30 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $30 | $30 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $1,236 | $2,441 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $95 | $95 | $95 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $114 | $119 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $153 | $159 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $42 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $73 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $12 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $136 | $165 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $172 | $196 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $71 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $67 | $79 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $110 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $92 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $137 | $174 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $101 | $118 | $150 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $101 | $117 | $132 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $50 | $68 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $123 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $101 | $126 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $46 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $367 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $379 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $112 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $106 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $73 | $97 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $111 | $139 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $135 | $151 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $179 | $207 | $224 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $32 | $53 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $54 | $57 |