| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,124 | $2,841 | $6,865 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $586 | $3,635 | $6,147 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $62 | $129 | $284 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $39 | $172 | $329 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $84 | $217 | $429 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $29 | $105 | $197 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $140 | $224 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $25 | $33 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $147 | $285 | $393 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $154 | $279 | $443 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $67 | $105 | $168 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $110 | $227 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $88 | $136 | $245 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $80 | $150 | $291 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $133 | $254 | $401 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $94 | $192 | $379 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $258 | $455 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $66 | $115 | $218 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $85 | $149 | $229 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $88 | $175 | $365 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $49 | $90 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $64 | $164 | $385 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $250 | $412 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $91 | $189 | $346 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $40 | $409 | $973 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $473 | $979 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $54 | $173 | $368 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $70 | $239 | $531 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $113 | $228 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $34 | $121 | $294 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $42 | $176 | $574 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $217 | $699 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $65 | $202 | $416 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $93 | $327 | $678 |
| EEG monitoring continuous 24 hours CPT 95950 • Neurology | $102 | $102 | $102 |
| EEG monitoring continuous 24 hours with video CPT 95951 • Neurology | $3,152 | $3,152 | $3,152 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $94 | $150 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $84 | $128 | $229 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $85 | $224 | $339 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $144 | $340 | $552 |
| Office visit established patient minimal CPT 99211 • Office Visits | $7 | $29 | $57 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $32 | $70 | $117 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $111 | $185 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $69 | $140 | $260 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $102 | $272 | $452 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $68 | $131 | $198 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $204 | $314 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $163 | $286 | $418 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $50 | $66 | $94 |