| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $651 | $1,272 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $30 | $1,115 | $2,200 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $95 | $99 | $104 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $110 | $115 | $120 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $132 | $170 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $42 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $85 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $10 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $102 | $151 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $186 | $256 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $61 | $74 | $102 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $63 | $67 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $92 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $75 | $88 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $101 | $119 | $138 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $101 | $104 | $111 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $118 | $134 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $82 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $113 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $103 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $43 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $131 | $131 | $131 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $136 | $136 | $137 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $360 | $360 | $361 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $368 | $373 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $149 | $149 | $149 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $101 | $124 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $162 | $162 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $264 | $264 | $264 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $68 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $107 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $155 | $160 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $178 | $195 | $205 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $19 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $51 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $55 | $73 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $81 | $122 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $137 | $155 | $171 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $58 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $111 | $121 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $140 | $155 | $166 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $44 | $47 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $67 | $91 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $82 | $108 |