| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,212 | $2,212 | $2,212 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $30 | $30 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $30 | $30 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $95 | $99 | $104 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $110 | $110 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $154 | $162 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $48 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $85 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $8 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $158 | $229 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $192 | $256 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $61 | $69 | $82 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $72 | $106 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $91 | $118 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $92 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $144 | $152 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $125 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $151 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $63 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $105 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $101 | $131 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $29 | $44 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $137 | $137 | $137 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $356 | $361 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $379 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $105 | $105 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $149 | $149 | $149 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $124 | $124 | $124 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $162 | $162 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $264 | $264 | $264 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $69 | $76 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $121 | $131 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $141 | $237 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $191 | $215 | $250 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $25 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $56 | $58 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $69 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $82 | $115 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $173 | $191 | $216 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $51 | $65 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $98 | $103 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $158 | $168 | $182 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $44 | $47 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $73 | $116 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $85 | $121 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $63 | $85 |