| Insertion cervical dilator CPT 59200 • Maternity | $96 | $96 | $96 |
| Vaginal delivery only CPT 59409 • Maternity | $669 | $669 | $669 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $891 | $891 | $891 |
| External cephalic version CPT 59412 • Maternity | $85 | $85 | $85 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $888 | $888 | $888 |
| Postpartum care only CPT 59430 • Maternity | $232 | $232 | $232 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,244 | $2,244 | $2,244 |
| Cesarean delivery only CPT 59514 • Maternity | $751 | $751 | $751 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,122 | $2,122 | $2,122 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $68 | $96 | $124 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $68 | $105 | $143 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $126 | $126 | $126 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $45 | $45 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $73 | $98 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $12 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $249 | $249 | $250 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $278 | $278 | $278 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $107 | $107 | $107 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $98 | $98 | $98 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $125 | $125 | $125 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $106 | $106 | $106 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $184 | $184 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $165 | $165 | $165 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $201 | $201 | $201 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $65 | $65 | $65 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $135 | $135 | $135 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $141 | $141 | $141 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $38 | $38 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $132 | $132 | $132 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $135 | $135 | $135 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $130 | $130 | $130 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $106 | $269 | $431 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $120 | $310 | $501 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $92 | $114 | $125 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $115 | $158 | $179 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $80 | $108 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $41 | $70 | $99 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $51 | $99 | $124 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $61 | $61 | $61 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $80 | $137 | $194 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $132 | $224 | $316 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $42 | $54 | $67 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $62 | $82 | $103 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $88 | $131 | $154 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $110 | $145 | $203 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $21 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $31 | $41 | $52 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $42 | $63 | $84 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $53 | $97 | $119 |