| Antepartum care 7 or more visits CPT 59426 • Maternity | $682 | $682 | $682 |
| Postpartum care only CPT 59430 • Maternity | $154 | $154 | $154 |
| Cesarean delivery only CPT 59514 • Maternity | $791 | $791 | $791 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $40 | $40 | $40 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,200 | $2,200 | $2,200 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $77 | $77 | $77 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $89 | $89 | $89 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $32 | $32 | $32 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $12 | $18 | $24 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $15 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $119 | $119 | $120 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $157 | $157 | $158 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $68 | $68 | $68 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $71 | $71 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $91 | $91 | $91 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $116 | $116 | $116 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $119 | $119 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $143 | $143 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $58 | $58 | $58 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $82 | $82 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $114 | $114 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $45 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $127 | $127 | $127 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $110 | $110 | $110 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $110 | $110 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $303 | $303 | $303 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $352 | $352 | $352 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $103 | $103 | $104 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $148 | $148 | $148 |
| EMG needle each extremity complete CPT 95886 • Neurology | $77 | $77 | $77 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $107 | $108 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $168 | $168 | $168 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $258 | $258 | $258 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $77 | $77 | $77 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $112 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $128 | $150 | $172 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $217 | $217 | $217 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $22 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $45 | $45 | $45 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $75 | $75 | $75 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $111 | $111 | $111 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $150 | $150 | $150 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $139 | $139 | $139 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $144 | $144 | $144 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $166 | $190 | $213 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $76 | $76 | $76 |