| Fetal non-stress test CPT 59025 • Maternity | $28 | $48 | $69 |
| Insertion cervical dilator CPT 59200 • Maternity | $61 | $61 | $61 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $75 | $1,435 | $2,795 |
| Vaginal delivery only CPT 59409 • Maternity | $25 | $41 | $58 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $33 | $45 | $58 |
| External cephalic version CPT 59412 • Maternity | $3 | $30 | $58 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $32 | $776 | $1,520 |
| Postpartum care only CPT 59430 • Maternity | $8 | $200 | $392 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $83 | $1,439 | $2,795 |
| Cesarean delivery only CPT 59514 • Maternity | $28 | $43 | $58 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $41 | $49 | $58 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $79 | $1,749 | $3,420 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $66 | $86 | $107 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $58 | $62 | $67 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $6 | $138 | $271 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $58 | $66 | $75 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $84 | $155 | $226 |
| Interactive complexity add-on CPT 90785 • Mental Health | $21 | $21 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $5 | $108 | $210 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $6 | $128 | $249 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $92 | $101 | $110 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $97 | $105 | $113 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $3 | $75 | $147 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $3 | $73 | $143 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $5 | $112 | $220 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $3 | $95 | $188 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $5 | $117 | $229 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $98 | $98 | $98 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $3 | $3 | $3 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $3 | $3 | $3 |
| Group psychotherapy CPT 90853 • Mental Health | $37 | $37 | $37 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $149 | $212 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $4 | $105 | $206 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $4 | $102 | $200 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $78 | $311 | $544 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $78 | $361 | $645 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $92 | $92 | $92 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $5 | $5 | $5 |
| EMG needle each extremity complete CPT 95886 • Neurology | $78 | $113 | $148 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $73 | $73 | $73 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $91 | $139 | $186 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $82 | $153 | $223 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $6 | $149 | $293 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $9 | $238 | $467 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $67 | $77 | $87 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $4 | $31 | $58 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $5 | $75 | $145 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $7 | $122 | $237 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $22 | $33 |