| Antepartum care 7 or more visits CPT 59426 • Maternity | $50 | $928 | $1,353 |
| Postpartum care only CPT 59430 • Maternity | $118 | $216 | $347 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $30 | $2,181 | $3,517 |
| Cesarean delivery only CPT 59514 • Maternity | $850 | $1,055 | $1,181 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $30 | $1,181 | $1,749 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,800 | $2,181 | $2,520 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $58 | $138 | $174 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $44 | $128 | $180 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $155 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $57 | $107 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $99 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $22 | $39 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $142 | $216 | $369 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $153 | $254 | $398 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $106 | $178 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $72 | $105 | $182 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $133 | $201 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $123 | $231 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $140 | $212 | $353 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $120 | $173 | $305 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $208 | $369 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $100 | $177 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $115 | $147 | $243 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $156 | $251 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $46 | $62 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $16 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $194 | $405 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $166 | $218 | $361 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $127 | $180 | $303 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $52 | $326 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $361 | $596 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $49 | $133 | $223 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $202 | $323 |
| EMG needle each extremity complete CPT 95886 • Neurology | $43 | $100 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $51 | $114 | $179 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $61 | $174 | $291 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $72 | $163 | $350 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $195 | $240 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $96 | $354 | $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 | $57 | $100 | $215 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $80 | $154 | $311 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $191 | $403 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $171 | $278 | $589 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $26 | $50 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $62 | $108 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $56 | $93 | $179 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $71 | $162 | $309 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $114 | $232 | $413 |