| Chorionic villus sampling CPT 59015 • Maternity | $178 | $178 | $178 |
| Fetal non-stress test CPT 59025 • Maternity | $55 | $55 | $55 |
| Insertion cervical dilator CPT 59200 • Maternity | $119 | $119 | $119 |
| Vaginal delivery only CPT 59409 • Maternity | $914 | $914 | $915 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,210 | $1,210 | $1,210 |
| External cephalic version CPT 59412 • Maternity | $116 | $116 | $116 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,169 | $1,169 | $1,169 |
| Postpartum care only CPT 59430 • Maternity | $301 | $301 | $301 |
| Cesarean delivery only CPT 59514 • Maternity | $1,033 | $1,033 | $1,033 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,485 | $1,485 | $1,485 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,150 | $2,150 | $2,150 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $97 | $97 | $97 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $111 | $111 | $111 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $145 | $145 | $146 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $67 | $67 | $67 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $77 | $77 | $77 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $137 | $149 | $162 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $180 | $180 | $181 |
| 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 | $78 | $85 | $93 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $62 | $72 | $81 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $136 | $136 | $136 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $107 | $107 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $130 | $130 | $130 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $43 | $54 | $65 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $88 | $89 | $89 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $93 | $93 |
| Group psychotherapy CPT 90853 • Mental Health | $16 | $16 | $16 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $153 | $153 | $153 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $158 | $158 | $158 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $158 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $379 | $379 | $380 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $440 | $440 | $440 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $113 | $113 | $113 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $162 | $162 | $162 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $98 | $98 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $91 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $113 | $113 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $136 | $136 | $136 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $178 | $178 | $178 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $291 | $291 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $59 | $60 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $92 | $92 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $83 | $111 | $138 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $183 | $183 | $183 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $46 | $47 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $74 | $74 | $75 |