| Fetal non-stress test CPT 59025 • Maternity | $46 | $46 | $46 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $30 | $30 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $991 | $1,952 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $30 | $1,304 | $2,578 |
| External cephalic version CPT 59412 • Maternity | $248 | $248 | $248 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $2,482 | $2,482 | $2,482 |
| Postpartum care only CPT 59430 • Maternity | $645 | $645 | $645 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $6,420 | $6,420 | $6,420 |
| Cesarean delivery only CPT 59514 • Maternity | $2,203 | $2,203 | $2,203 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $1,600 | $3,169 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $1,236 | $2,441 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $104 | $104 | $104 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $154 | $154 | $154 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $30 | $30 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $82 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $151 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $152 | $153 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $47 | $74 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $37 | $82 | $106 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $65 | $97 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $55 | $91 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $85 | $135 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $96 | $130 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $95 | $129 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $4 | $53 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $109 | $128 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $139 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $42 | $44 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $407 | $407 | $407 |
| 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 | $351 | $359 | $367 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $22 | $22 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $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 | $35 | $65 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $58 | $93 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $155 | $196 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $90 | $194 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $41 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $48 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $62 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $84 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $75 | $124 | $173 |