| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,925 | $2,610 | $3,260 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $55 | $81 | $130 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $42 | $85 | $133 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $214 | $301 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $52 | $86 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $78 | $146 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $14 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $83 | $152 | $192 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $86 | $204 | $398 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $92 | $178 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $26 | $90 | $182 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $77 | $120 | $201 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $34 | $118 | $231 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $100 | $157 | $190 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $52 | $128 | $164 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $93 | $207 | $369 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $100 | $177 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $141 | $243 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $77 | $151 | $251 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $42 | $62 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $53 | $139 | $232 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $92 | $147 | $198 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $121 | $166 | $303 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $221 | $415 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $85 | $251 | $446 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $70 | $99 | $174 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $59 | $102 | $151 |
| EMG needle each extremity complete CPT 95886 • Neurology | $34 | $71 | $117 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $74 | $98 | $137 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $38 | $134 | $291 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $85 | $114 | $158 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $84 | $171 | $301 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $149 | $400 | $759 |
| EEG monitoring continuous 24 hours CPT 95950 • Neurology | $854 | $854 | $854 |
| EEG monitoring continuous 24 hours with video CPT 95951 • Neurology | $5,680 | $5,680 | $5,680 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $54 | $103 | $215 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $42 | $129 | $311 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $42 | $193 | $403 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $42 | $186 | $301 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $26 | $50 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $21 | $50 | $108 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $35 | $75 | $106 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $42 | $133 | $309 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $42 | $174 | $413 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $42 | $129 | $285 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $42 | $132 | $203 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $42 | $237 | $485 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $31 | $43 | $58 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $42 | $73 | $107 |