| Amniocentesis diagnostic CPT 59000 • Maternity | $107 | $107 | $107 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $30 | $30 | $30 |
| Fetal non-stress test CPT 59025 • Maternity | $18 | $31 | $45 |
| Insertion cervical dilator CPT 59200 • Maternity | $30 | $30 | $30 |
| Vaginal delivery only CPT 59409 • Maternity | $30 | $381 | $731 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $30 | $30 | $30 |
| External cephalic version CPT 59412 • Maternity | $94 | $94 | $94 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $942 | $942 | $942 |
| Postpartum care only CPT 59430 • Maternity | $243 | $243 | $243 |
| Cesarean delivery only CPT 59514 • Maternity | $1,490 | $1,490 | $1,490 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $30 | $30 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $1,115 | $2,200 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $104 | $104 | $104 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $120 | $120 | $120 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $154 | $154 | $154 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $38 | $45 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $82 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $9 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $153 | $172 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $173 | $182 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $66 | $79 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $82 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $65 | $97 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $96 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $128 | $128 | $128 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $102 | $105 | $108 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $124 | $124 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $52 | $67 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $83 | $117 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $86 | $118 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $23 | $23 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $131 | $131 | $131 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $135 | $136 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $360 | $363 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $418 | $418 | $418 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $149 | $155 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $50 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $70 | $102 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $169 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $264 | $275 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $68 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $103 | $103 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $93 | $128 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $202 | $202 | $202 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $53 | $55 |