| Chorionic villus sampling CPT 59015 • Maternity | $154 | $154 | $154 |
| Fetal non-stress test CPT 59025 • Maternity | $27 | $37 | $47 |
| Insertion cervical dilator CPT 59200 • Maternity | $101 | $101 | $101 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,861 | $2,106 | $2,351 |
| Vaginal delivery only CPT 59409 • Maternity | $649 | $721 | $793 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,048 | $1,048 | $1,048 |
| External cephalic version CPT 59412 • Maternity | $101 | $101 | $101 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,003 | $1,003 | $1,003 |
| Postpartum care only CPT 59430 • Maternity | $216 | $237 | $257 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,212 | $2,407 | $2,601 |
| Cesarean delivery only CPT 59514 • Maternity | $898 | $898 | $898 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,288 | $1,288 | $1,288 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,463 | $2,463 | $2,463 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $41 | $68 | $95 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $111 | $112 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $69 | $119 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $40 | $59 | $71 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $70 | $74 | $77 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $9 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $157 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $167 | $178 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $79 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $63 | $79 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $78 | $99 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $93 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $123 | $146 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $118 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $128 | $149 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $71 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $109 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $109 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $42 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $143 | $143 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $147 | $147 | $147 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $119 | $119 | $119 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $343 | $343 | $343 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $216 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $103 | $103 | $103 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $77 | $77 | $77 |
| EMG needle each extremity complete CPT 95886 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $33 | $33 | $33 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $75 | $75 | $75 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $163 | $163 | $163 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $91 | $91 | $91 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $43 | $61 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $101 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $146 | $155 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $131 | $169 | $215 |