| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,198 | $2,198 | $2,198 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $111 | $111 | $111 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $127 | $127 | $127 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $79 | $79 | $79 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $29 | $29 | $29 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $87 | $87 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $14 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $149 | $155 | $161 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $180 | $188 | $195 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $76 | $76 | $76 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $89 | $89 | $89 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $65 | $65 | $65 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $147 | $147 | $147 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $115 | $115 | $115 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $141 | $141 | $141 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $52 | $52 | $52 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $100 | $100 | $100 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $20 | $20 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $121 | $121 | $121 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $127 | $127 | $127 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $120 | $120 | $120 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $355 | $355 | $355 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $412 | $412 | $412 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $103 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $144 | $144 | $144 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $84 | $84 | $84 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $104 | $105 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $165 | $165 | $165 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $270 | $270 | $270 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $63 | $63 | $63 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $97 | $97 | $97 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $146 | $147 | $147 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $194 | $194 | $194 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $20 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $49 | $49 | $49 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $79 | $79 | $79 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $113 | $113 | $113 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $158 | $158 | $158 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $72 | $72 | $72 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $114 | $114 | $114 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $152 | $153 | $153 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $70 | $70 | $70 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $105 | $105 | $105 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $71 | $71 | $71 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $101 | $101 | $101 |
| Consultation office low complexity CPT 99243 • Office Visits | $107 | $107 | $108 |