| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $586 | $2,062 | $3,561 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $48 | $73 | $103 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $48 | $67 | $118 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $72 | $174 | $290 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $82 | $118 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $44 | $73 | $97 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $13 | $24 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $133 | $173 | $246 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $125 | $168 | $276 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $79 | $129 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $75 | $110 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $114 | $153 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $99 | $136 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $159 | $227 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $143 | $181 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $156 | $191 | $218 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $74 | $96 | $107 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $96 | $113 | $144 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $109 | $124 | $151 |
| Group psychotherapy CPT 90853 • Mental Health | $35 | $40 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $83 | $129 | $171 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $116 | $168 | $199 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $116 | $142 | $198 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $59 | $262 | $526 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $59 | $239 | $421 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $54 | $84 | $108 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $45 | $115 | $166 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $78 | $101 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $83 | $109 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $76 | $114 | $198 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $113 | $158 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $157 | $312 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $216 | $306 | $413 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $40 | $72 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $80 | $119 | $172 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $160 | $241 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $207 | $318 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $21 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $50 | $82 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $53 | $77 | $120 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $71 | $111 | $185 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $163 | $305 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $110 | $134 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $124 | $147 | $184 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $172 | $222 | $315 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $50 | $87 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $81 | $99 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $120 | $167 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $74 | $93 | $116 |