| Antepartum care 7 or more visits CPT 59426 • Maternity | $568 | $568 | $568 |
| Postpartum care only CPT 59430 • Maternity | $151 | $151 | $151 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,097 | $2,097 | $2,097 |
| Cesarean delivery only CPT 59514 • Maternity | $1,096 | $1,096 | $1,096 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,237 | $1,237 | $1,237 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,954 | $1,954 | $1,954 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $55 | $55 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $84 | $84 | $84 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $109 | $109 | $109 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $71 | $82 | $94 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $60 | $60 | $60 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $140 | $166 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $145 | $168 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $75 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $49 | $76 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $96 | $113 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $98 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $133 | $159 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $130 | $137 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $176 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $95 | $95 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $103 | $126 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $123 | $136 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $34 | $56 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $180 | $180 | $180 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $197 | $197 | $197 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $146 | $146 | $146 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $192 | $192 | $192 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $100 | $100 | $100 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $39 | $39 | $39 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $30 | $30 |
| EMG needle each extremity complete CPT 95886 • Neurology | $102 | $102 | $102 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $110 | $110 | $110 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $58 | $58 | $58 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $162 | $162 | $162 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $219 | $219 | $219 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $50 | $60 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $77 | $93 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $144 | $154 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $152 | $183 | $215 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $41 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $55 | $72 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $63 | $94 | $124 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $101 | $138 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $73 | $121 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $120 | $145 | $170 |