| Cesarean delivery only CPT 59514 • Maternity | $884 | $884 | $884 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $30 | $30 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $488 | $1,465 | $2,441 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $85 | $94 | $103 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $98 | $108 | $119 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $43 | $51 | $59 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $27 | $64 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $122 | $166 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $165 | $168 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $72 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $86 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $93 | $110 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $111 | $134 | $157 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $144 | $144 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $150 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $61 | $61 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $150 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $157 | $157 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $67 | $67 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $132 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $133 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $310 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $97 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $67 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $78 | $78 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $20 | $49 | $78 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $79 | $98 | $117 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $150 | $171 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $205 | $214 | $222 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $21 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $55 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $69 | $79 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $48 | $85 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $149 | $157 | $165 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $71 | $109 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $136 | $159 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $201 | $222 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $61 | $86 | $111 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $62 | $87 | $111 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $107 | $111 |