| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $1,090 | $2,150 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $97 | $97 | $97 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $111 | $111 | $111 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $69 | $107 | $146 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $49 | $67 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $46 | $61 | $77 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $10 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $105 | $154 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $157 | $180 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $71 | $72 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $63 | $64 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $95 | $111 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $100 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $136 | $167 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $94 | $103 | $107 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $114 | $122 | $130 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $75 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $95 | $124 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $120 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $31 | $40 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $153 | $153 | $153 |
| 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 | $379 | $379 | $380 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $440 | $440 | $440 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $113 | $113 | $113 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $162 | $162 | $162 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $98 | $98 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $91 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $113 | $113 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $136 | $136 | $136 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $178 | $178 | $178 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $291 | $291 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $63 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $92 | $92 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $110 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $113 | $179 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $23 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $49 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $63 | $86 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $98 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $147 | $148 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $55 | $69 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $101 | $109 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $145 | $169 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $41 | $44 | $47 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $53 | $66 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $81 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $58 | $77 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $106 | $130 |