| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,559 | $2,559 | $2,559 |
| Cesarean delivery only CPT 59514 • Maternity | $30 | $30 | $30 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $758 | $1,485 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,836 | $1,836 | $1,836 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $59 | $59 | $59 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $119 | $119 | $119 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $146 | $146 | $146 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $30 | $30 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $39 | $73 | $98 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $9 | $12 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $125 | $147 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $164 | $172 | $187 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $69 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $70 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $94 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $68 | $77 | $89 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $118 | $137 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $94 | $115 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $134 | $142 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $69 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $95 | $106 | $118 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $81 | $111 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $49 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $158 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $317 | $349 | $380 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $370 | $370 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $124 | $136 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $162 | $179 | $195 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $90 | $91 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $123 | $135 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $136 | $136 | $136 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $177 | $178 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $288 | $291 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $68 | $78 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $109 | $117 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $149 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $143 | $175 | $222 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $22 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $45 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $70 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $83 | $122 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $142 | $154 | $171 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $85 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $124 | $141 | $159 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $179 | $222 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $67 | $111 |