| Obstetric ultrasound limited CPT 76815 • Maternity | $50 | $73 | $104 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $33 | $67 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $8 | $10 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $145 | $157 | $162 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $131 | $147 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $72 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $43 | $67 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $67 | $98 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $71 | $80 | $88 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $101 | $119 | $138 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $160 | $259 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $220 | $416 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $80 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $132 | $211 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $85 | $110 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $41 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $6 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $75 | $247 | $419 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $86 | $153 | $220 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $42 | $155 | $268 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $178 | $281 | $383 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $116 | $308 | $430 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $33 | $44 | $56 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $115 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $49 | $49 | $49 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $120 | $222 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $81 | $177 | $274 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $61 | $86 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $42 | $115 | $188 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $143 | $168 | $193 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $83 | $136 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $45 | $74 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $106 | $161 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $22 | $104 | $160 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $19 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $47 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $7 | $46 | $77 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $70 | $88 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $26 | $88 | $168 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $50 | $91 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $13 | $99 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $45 | $116 | $160 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $6 | $54 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $82 | $130 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $97 | $127 | $171 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $10 | $68 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $47 | $131 | $203 |
| Consultation office straightforward CPT 99241 • Office Visits | $29 | $29 | $29 |
| Consultation office low complexity CPT 99243 • Office Visits | $92 | $155 | $256 |
| Consultation office high complexity CPT 99245 • Office Visits | $27 | $115 | $202 |