| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,623 | $2,440 | $3,311 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $48 | $134 | $279 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $48 | $286 | $1,350 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $94 | $187 | $291 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $34 | $212 | $1,388 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $94 | $164 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $13 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $101 | $329 | $1,882 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $304 | $1,097 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $41 | $83 | $110 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $60 | $81 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $78 | $152 | $459 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $91 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $113 | $181 | $459 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $123 | $142 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $179 | $229 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $84 | $110 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $106 | $127 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $118 | $140 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $65 | $247 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $18 | $91 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $63 | $142 | $262 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $130 | $179 | $304 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $141 | $157 | $200 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $260 | $559 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $109 | $342 | $676 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $42 | $83 | $114 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $123 | $287 |
| EMG needle each extremity complete CPT 95886 • Neurology | $53 | $209 | $1,226 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $73 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $120 | $209 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $76 | $140 | $249 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $99 | $314 | $965 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $144 | $298 | $505 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $48 | $83 | $212 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $107 | $278 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $187 | $381 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $207 | $391 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $18 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $54 | $192 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $85 | $231 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $121 | $278 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $151 | $319 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $104 | $174 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $166 | $234 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $147 | $216 | $318 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $56 | $99 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $80 | $124 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $125 | $204 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $64 | $85 | $124 |