| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,212 | $2,212 | $2,212 |
| Cesarean delivery only CPT 59514 • Maternity | $148 | $148 | $148 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,366 | $1,366 | $1,366 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,429 | $2,429 | $2,429 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $38 | $38 | $38 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $110 | $110 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $170 | $170 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $25 | $25 | $25 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $83 | $83 | $83 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $125 | $125 | $125 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $106 | $106 | $106 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $78 | $78 | $78 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $82 | $82 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $84 | $84 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $121 | $121 | $121 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $92 | $92 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $145 | $145 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $46 | $46 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $78 | $78 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $76 | $76 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $62 | $62 | $62 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $379 | $379 |
| EMG needle each extremity complete CPT 95886 • Neurology | $104 | $104 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $150 | $150 | $150 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $177 | $177 | $177 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $318 | $318 | $318 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $86 | $86 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $92 | $92 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $174 | $174 | $174 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $273 | $273 | $273 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $54 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $102 | $102 | $102 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $138 | $138 | $138 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $185 | $185 | $185 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $65 | $65 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $148 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $137 | $137 | $137 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $72 | $72 | $72 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $92 | $92 | $92 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $75 | $75 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $103 | $103 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $758 | $758 | $758 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $245 | $245 | $245 |