| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $1,225 | $2,855 | $4,313 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $53 | $114 | $192 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $39 | $87 | $132 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $249 | $474 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $39 | $94 | $229 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $81 | $159 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $17 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $98 | $248 | $339 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $225 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $106 | $162 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $92 | $166 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $145 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $133 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $122 | $220 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $194 | $278 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $233 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $114 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $165 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $184 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $46 | $71 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $79 | $188 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $82 | $253 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $128 | $228 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $70 | $318 | $706 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $40 | $168 | $645 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $43 | $129 | $284 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $144 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $92 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $117 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $42 | $159 | $292 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $69 | $201 | $345 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $91 | $181 | $336 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $102 | $398 | $753 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $48 | $81 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $84 | $120 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $108 | $218 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $154 | $253 | $403 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $26 | $55 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $37 | $59 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $56 | $97 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $61 | $144 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $114 | $188 | $281 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $132 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $174 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $146 | $237 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $57 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $105 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $145 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $64 | $102 | $143 |