| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $41 | $41 | $41 |
| Chorionic villus sampling CPT 59015 • Maternity | $41 | $41 | $41 |
| Fetal non-stress test CPT 59025 • Maternity | $42 | $42 | $42 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $41 | $41 | $41 |
| Vaginal delivery only CPT 59409 • Maternity | $636 | $636 | $636 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $41 | $41 | $41 |
| External cephalic version CPT 59412 • Maternity | $82 | $82 | $82 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $664 | $664 | $664 |
| Postpartum care only CPT 59430 • Maternity | $137 | $137 | $137 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $41 | $41 | $41 |
| Cesarean delivery only CPT 59514 • Maternity | $721 | $721 | $721 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $978 | $978 | $978 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $41 | $41 | $41 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $111 | $111 | $111 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $124 | $124 | $124 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $85 | $85 | $85 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $140 | $140 | $140 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $168 | $168 | $169 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $75 | $75 | $75 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $85 | $85 | $85 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $110 | $110 | $110 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $90 | $90 | $90 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $113 | $113 | $113 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $138 | $138 | $138 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $165 | $165 | $165 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $70 | $70 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $130 | $130 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $130 | $130 | $130 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $30 | $30 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $131 | $131 | $131 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $41 | $41 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $102 | $102 | $102 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $273 | $273 | $273 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $305 | $305 | $305 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $83 | $83 | $83 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $121 | $121 | $121 |
| EMG needle each extremity complete CPT 95886 • Neurology | $81 | $81 | $81 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $87 | $87 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $108 | $108 | $108 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $170 | $170 | $170 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $278 | $278 | $278 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $36 | $36 | $36 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $36 | $36 | $36 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $38 | $40 | $41 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $38 | $40 | $41 |
| Office visit established patient minimal CPT 99211 • Office Visits | $24 | $24 | $24 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $24 | $24 | $24 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $24 | $24 | $24 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $38 | $38 | $38 |