| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $586 | $2,987 | $5,317 |
| Vaginal delivery only CPT 59409 • Maternity | $482 | $3,558 | $6,954 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $586 | $3,705 | $6,954 |
| External cephalic version CPT 59412 • Maternity | $62 | $136 | $261 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $464 | $1,122 | $2,097 |
| Postpartum care only CPT 59430 • Maternity | $147 | $2,498 | $6,953 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $1,630 | $3,024 | $5,884 |
| Cesarean delivery only CPT 59514 • Maternity | $127 | $1,166 | $2,302 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $811 | $4,357 | $7,945 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $586 | $2,569 | $5,575 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $96 | $229 | $450 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $47 | $197 | $522 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $245 | $660 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $37 | $117 | $310 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $73 | $152 | $356 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $17 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $113 | $161 | $183 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $145 | $244 | $398 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $55 | $74 | $89 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $48 | $100 | $182 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $94 | $130 | $201 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $79 | $133 | $231 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $110 | $153 | $187 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $94 | $129 | $154 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $178 | $244 | $369 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $55 | $73 | $88 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $96 | $149 | $243 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $119 | $160 | $251 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $44 | $62 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $9 | $16 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $53 | $2,495 | $6,953 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $111 | $3,075 | $6,954 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $142 | $3,102 | $6,954 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $308 | $459 | $873 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $47 | $449 | $1,005 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $42 | $148 | $289 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $70 | $180 | $409 |
| EMG needle each extremity complete CPT 95886 • Neurology | $42 | $105 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $43 | $103 | $150 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $54 | $167 | $291 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $74 | $202 | $350 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $87 | $223 | $301 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $98 | $422 | $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 | $60 | $69 | $84 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $142 | $311 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $194 | $403 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $171 | $203 | $237 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $30 | $50 |