| Fetal non-stress test CPT 59025 • Maternity | $29 | $29 | $29 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $55 | $55 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,453 | $2,453 | $2,453 |
| Vaginal delivery only CPT 59409 • Maternity | $795 | $795 | $795 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,031 | $1,031 | $1,031 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $250 | $250 | $250 |
| Postpartum care only CPT 59430 • Maternity | $168 | $168 | $168 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,579 | $2,579 | $2,579 |
| 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 | $115 | $115 | $115 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $83 | $83 | $83 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $24 | $24 | $24 |
| 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 | $143 | $150 | $157 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $205 | $205 | $205 |
| 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 | $99 | $119 | $139 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $105 | $105 | $105 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $120 | $120 | $120 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $56 | $56 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $104 | $104 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $102 | $102 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $4 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $69 | $69 | $69 |
| 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 | $53 | $69 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $69 | $108 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $109 | $189 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $273 | $273 | $273 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $25 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $42 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $70 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $76 | $123 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $108 | $185 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $76 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $148 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $230 | $230 | $230 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |