| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $297 | $297 | $297 |
| Chorionic villus sampling CPT 59015 • Maternity | $225 | $225 | $225 |
| Fetal non-stress test CPT 59025 • Maternity | $44 | $44 | $44 |
| Insertion cervical dilator CPT 59200 • Maternity | $66 | $66 | $66 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,604 | $2,604 | $2,604 |
| Vaginal delivery only CPT 59409 • Maternity | $1,121 | $1,121 | $1,121 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,311 | $1,311 | $1,311 |
| External cephalic version CPT 59412 • Maternity | $151 | $151 | $151 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,183 | $1,183 | $1,183 |
| Postpartum care only CPT 59430 • Maternity | $183 | $183 | $183 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,949 | $2,949 | $2,949 |
| Cesarean delivery only CPT 59514 • Maternity | $1,331 | $1,331 | $1,331 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,584 | $1,584 | $1,584 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,741 | $2,741 | $2,741 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $112 | $112 | $112 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $77 | $77 | $77 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $146 | $146 | $146 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $131 | $131 | $131 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $58 | $58 | $58 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $8 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $247 | $247 | $247 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $206 | $206 | $206 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $68 | $68 | $68 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $134 | $134 | $134 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $112 | $112 | $112 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $184 | $184 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $179 | $179 | $179 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $135 | $135 | $135 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $168 | $168 | $168 |
| Group psychotherapy CPT 90853 • Mental Health | $49 | $49 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $8 | $8 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $220 | $220 | $220 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $236 | $236 | $236 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $163 | $163 | $163 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $359 | $359 | $359 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $84 | $84 | $84 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $76 | $76 | $76 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $184 | $184 | $184 |
| EMG needle each extremity complete CPT 95886 • Neurology | $78 | $78 | $78 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $85 | $85 | $85 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $107 | $107 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $224 | $224 | $224 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $170 | $170 | $170 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $183 | $183 | $183 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $103 | $103 | $103 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $149 | $149 | $149 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $190 | $190 | $190 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $292 | $292 | $292 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $26 | $29 |