| Antepartum care 7 or more visits CPT 59426 • Maternity | $861 | $861 | $861 |
| Postpartum care only CPT 59430 • Maternity | $144 | $144 | $144 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,218 | $2,218 | $2,218 |
| Cesarean delivery only CPT 59514 • Maternity | $1,046 | $1,046 | $1,046 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,226 | $1,226 | $1,226 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,055 | $2,055 | $2,055 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $49 | $49 | $49 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $85 | $85 | $85 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $225 | $225 | $225 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $32 | $51 | $71 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $96 | $96 | $96 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $134 | $162 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $138 | $165 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $71 | $81 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $74 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $92 | $111 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $96 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $135 | $159 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $134 | $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 | $89 | $119 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $130 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $54 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $184 | $184 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $146 | $146 | $146 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $193 | $193 | $193 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $86 | $86 | $86 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $113 | $113 | $113 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $54 | $54 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $46 | $46 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $73 | $73 | $73 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $67 | $67 | $67 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $117 | $117 | $117 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $126 | $126 | $126 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $65 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $87 | $98 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $134 | $148 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $139 | $177 | $215 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $21 | $39 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $57 | $72 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $86 | $105 | $124 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $117 | $146 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $126 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $115 | $143 | $170 |