| Antepartum care 7 or more visits CPT 59426 • Maternity | $1,518 | $1,518 | $1,518 |
| Postpartum care only CPT 59430 • Maternity | $357 | $357 | $357 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $5,048 | $5,048 | $5,048 |
| Cesarean delivery only CPT 59514 • Maternity | $2,343 | $2,343 | $2,343 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $2,757 | $2,757 | $2,757 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $4,692 | $4,692 | $4,692 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $107 | $231 | $355 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $129 | $256 | $384 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $174 | $381 | $588 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $74 | $159 | $244 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $270 | $270 | $270 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $15 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $469 | $469 | $469 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $205 | $293 | $381 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $87 | $121 | $155 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $66 | $98 | $130 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $232 | $232 | $232 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $212 | $212 | $212 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $253 | $372 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $342 | $342 | $342 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $238 | $238 | $238 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $296 | $296 | $296 |
| Group psychotherapy CPT 90853 • Mental Health | $79 | $79 | $79 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $10 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $411 | $411 | $411 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $333 | $333 | $333 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $310 | $310 | $310 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $325 | $448 | $570 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $577 | $577 | $577 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $229 | $229 | $229 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $99 | $99 | $99 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $104 | $119 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $127 | $127 | $127 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $356 | $356 | $356 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $184 | $184 | $184 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $152 | $238 | $324 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $274 | $311 | $348 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $86 | $102 | $118 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $68 | $125 | $181 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $273 | $382 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $219 | $306 | $394 |
| Office visit established patient minimal CPT 99211 • Office Visits | $25 | $39 | $54 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $78 | $102 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $94 | $106 | $117 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $177 | $248 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $162 | $249 | $335 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $87 | $162 | $238 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $119 | $223 | $327 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $158 | $320 | $481 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $68 | $99 |