| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $155 | $155 | $155 |
| Fetal non-stress test CPT 59025 • Maternity | $38 | $38 | $38 |
| Insertion cervical dilator CPT 59200 • Maternity | $102 | $102 | $102 |
| Vaginal delivery only CPT 59409 • Maternity | $617 | $617 | $617 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $836 | $836 | $836 |
| External cephalic version CPT 59412 • Maternity | $79 | $79 | $79 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $799 | $799 | $799 |
| Postpartum care only CPT 59430 • Maternity | $203 | $203 | $203 |
| Cesarean delivery only CPT 59514 • Maternity | $699 | $699 | $699 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,035 | $1,035 | $1,035 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,950 | $1,950 | $1,950 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $120 | $120 | $120 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $138 | $138 | $138 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $36 | $66 | $95 |
| Interactive complexity add-on CPT 90785 • Mental Health | $12 | $12 | $12 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $129 | $137 | $151 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $167 | $167 | $167 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $70 | $70 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $64 | $64 | $64 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $54 | $54 | $54 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $120 | $120 | $120 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $109 | $109 | $109 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $132 | $132 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $43 | $43 | $43 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $65 | $65 | $65 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $92 | $92 | $92 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $21 | $21 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $126 | $126 | $126 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $120 | $120 | $120 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $352 | $352 | $352 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $410 | $410 | $410 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $100 | $100 | $101 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $141 | $141 | $141 |
| EMG needle each extremity complete CPT 95886 • Neurology | $85 | $85 | $85 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $80 | $80 | $80 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $100 | $100 | $101 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $121 | $121 | $121 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $158 | $158 | $158 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $259 | $259 | $259 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $54 | $54 | $54 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $85 | $85 | $85 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $128 | $128 | $128 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $169 | $169 | $169 |
| Office visit established patient minimal CPT 99211 • Office Visits | $4 | $4 | $4 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $43 | $43 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $69 | $69 | $69 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $98 | $98 | $98 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $138 | $138 | $138 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $62 | $62 | $62 |