| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $1,861 | $1,861 | $1,861 |
| Vaginal delivery only CPT 59409 • Maternity | $934 | $934 | $934 |
| Postpartum care only CPT 59430 • Maternity | $216 | $216 | $216 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,212 | $2,212 | $2,212 |
| Cesarean delivery only CPT 59514 • Maternity | $933 | $933 | $933 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $95 | $95 | $95 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $110 | $110 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $91 | $91 | $91 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $31 | $31 | $31 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $70 | $70 | $70 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $8 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $169 | $169 | $169 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $198 | $198 | $198 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $54 | $54 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $105 | $105 | $105 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $76 | $76 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $109 | $109 | $109 |
| 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 | $22 | $22 | $22 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $65 | $65 | $65 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $72 | $72 | $72 |
| EMG needle each extremity complete CPT 95886 • Neurology | $118 | $118 | $118 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $72 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $86 | $86 | $86 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $168 | $168 | $168 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $241 | $241 | $241 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $56 | $56 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $118 | $118 | $118 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $136 | $136 | $136 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $180 | $180 | $180 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $83 | $83 | $83 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $158 | $158 | $158 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $173 | $173 | $173 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $57 | $57 | $57 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $95 | $95 | $95 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $118 | $118 | $118 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $100 | $100 | $100 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $114 | $114 | $114 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $758 | $758 | $758 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $245 | $245 | $245 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $296 | $296 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $663 | $663 | $663 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $355 | $355 | $355 |