| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $131 | $131 | $131 |
| Chorionic villus sampling CPT 59015 • Maternity | $121 | $121 | $121 |
| Fetal non-stress test CPT 59025 • Maternity | $15 | $23 | $31 |
| Insertion cervical dilator CPT 59200 • Maternity | $41 | $41 | $41 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,200 | $2,200 | $2,200 |
| Vaginal delivery only CPT 59409 • Maternity | $471 | $471 | $471 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $599 | $775 | $952 |
| External cephalic version CPT 59412 • Maternity | $61 | $61 | $61 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $488 | $488 | $488 |
| Postpartum care only CPT 59430 • Maternity | $101 | $101 | $101 |
| Cesarean delivery only CPT 59514 • Maternity | $535 | $535 | $535 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $45 | $45 | $45 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $33 | $33 | $33 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $132 | $132 | $132 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $146 | $146 | $146 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $113 | $113 | $113 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $45 | $45 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $24 | $62 | $100 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $119 | $135 | $151 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $167 | $167 | $167 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $73 | $73 | $73 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $74 | $77 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $90 | $90 | $90 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $137 | $137 | $137 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $136 | $136 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $153 | $153 | $153 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $62 | $62 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $93 | $93 | $93 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $111 | $111 | $111 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $40 | $40 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $229 | $229 | $229 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $103 | $174 | $244 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $183 | $183 | $183 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $305 | $305 | $305 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $341 | $341 | $341 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $93 | $93 | $93 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $135 | $135 | $135 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $120 | $120 | $121 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $116 | $116 | $116 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $190 | $190 | $190 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $312 | $312 | $312 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $81 | $81 | $81 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $114 | $114 | $114 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $172 | $174 | $175 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $135 | $178 | $221 |