| Chorionic villus sampling CPT 59015 • Maternity | $60 | $60 | $60 |
| Fetal non-stress test CPT 59025 • Maternity | $20 | $20 | $20 |
| Insertion cervical dilator CPT 59200 • Maternity | $33 | $33 | $33 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $805 | $805 | $805 |
| Vaginal delivery only CPT 59409 • Maternity | $345 | $345 | $345 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $404 | $404 | $404 |
| External cephalic version CPT 59412 • Maternity | $47 | $47 | $47 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $366 | $366 | $366 |
| Postpartum care only CPT 59430 • Maternity | $62 | $62 | $62 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $912 | $912 | $912 |
| Cesarean delivery only CPT 59514 • Maternity | $411 | $411 | $411 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $489 | $489 | $489 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $848 | $848 | $848 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $43 | $43 | $43 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $123 | $123 | $123 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $164 | $164 | $164 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $76 | $76 | $76 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $32 | $32 | $32 |
| Interactive complexity add-on CPT 90785 • Mental Health | $2 | $2 | $2 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $74 | $74 | $74 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $59 | $59 | $59 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $24 | $24 | $24 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $20 | $20 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $39 | $39 | $39 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $33 | $33 | $33 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $54 | $54 | $54 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $53 | $53 | $53 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $80 | $80 | $80 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $41 | $41 | $41 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $40 | $40 | $40 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $46 | $46 | $46 |
| Group psychotherapy CPT 90853 • Mental Health | $15 | $15 | $15 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $2 | $2 | $2 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $36 | $36 | $36 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $73 | $73 | $73 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $51 | $51 | $51 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $85 | $85 | $85 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $120 | $120 | $120 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $38 | $38 | $38 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $55 | $55 | $55 |
| EMG needle each extremity complete CPT 95886 • Neurology | $23 | $23 | $23 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $21 | $21 | $21 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $25 | $25 | $25 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $30 | $30 | $30 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $90 | $90 | $90 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $31 | $31 | $31 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $45 | $45 | $45 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $70 | $70 | $70 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $73 | $73 | $73 |