| Obstetric ultrasound limited CPT 76815 • Maternity | $25 | $102 | $229 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $71 | $159 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $20 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $124 | $197 | $327 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $138 | $217 | $353 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $72 | $116 | $163 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $70 | $107 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $86 | $126 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $103 | $143 | $209 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $120 | $210 | $322 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $158 | $212 | $278 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $126 | $210 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $101 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $153 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $153 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $51 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $7 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $37 | $201 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $42 | $213 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $31 | $198 | $345 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $346 | $706 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $74 | $167 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $54 | $152 | $296 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $151 | $170 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $102 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $85 | $134 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $46 | $132 | $287 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $69 | $109 | $145 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $34 | $155 | $267 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $52 | $250 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $78 | $92 | $100 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $12 | $124 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $42 | $142 | $258 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $42 | $216 | $334 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $25 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $9 | $44 | $60 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $9 | $68 | $101 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $42 | $123 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $150 | $180 | $219 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $126 | $162 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $51 | $181 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $204 | $279 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $15 | $65 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $99 | $118 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $77 | $137 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $98 | $114 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $8 | $123 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $42 | $141 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $265 | $297 | $382 |