| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,382 | $2,596 | $3,462 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $49 | $97 | $156 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $49 | $106 | $180 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $77 | $124 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $73 | $90 | $126 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $64 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $7 | $13 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $134 | $185 | $247 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $86 | $193 | $276 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $90 | $108 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $74 | $97 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $87 | $120 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $85 | $106 | $123 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $100 | $157 | $209 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $112 | $147 | $163 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $135 | $217 | $257 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $48 | $105 | $128 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $115 | $135 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $70 | $127 | $142 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $39 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $64 | $150 | $203 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $73 | $195 | $304 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $81 | $184 | $334 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $75 | $330 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $265 | $413 | $596 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $47 | $88 | $115 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $127 | $145 | $168 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $75 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $54 | $87 | $170 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $38 | $99 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $63 | $130 | $206 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $108 | $169 | $271 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $163 | $279 | $445 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $53 | $68 | $101 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $101 | $155 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $133 | $232 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $184 | $306 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $19 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $21 | $32 | $43 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $70 | $126 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $92 | $179 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $136 | $250 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $75 | $170 | $427 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $95 | $135 | $186 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $135 | $206 | $273 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $44 | $52 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $55 | $75 | $98 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $81 | $106 | $141 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $86 | $109 |