| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $43 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $55 | $79 | $100 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $9 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $128 | $155 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $155 | $179 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $85 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $80 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $92 | $111 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $68 | $90 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $138 | $162 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $101 | $122 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $146 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $67 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $113 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $131 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $40 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $97 | $210 | $363 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $139 | $247 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $132 | $150 | $202 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $63 | $217 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $364 | $437 | $517 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $73 | $99 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $110 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $50 | $88 | $116 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $55 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $59 | $92 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $115 | $183 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $200 | $240 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $204 | $287 | $375 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $134 | $321 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $201 | $384 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $13 | $133 | $203 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $205 | $214 | $221 |
| Office visit established patient minimal CPT 99211 • Office Visits | $7 | $22 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $64 | $100 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $106 | $247 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $14 | $146 | $321 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $121 | $140 | $155 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $109 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $163 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $19 | $143 | $219 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $112 | $247 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $75 | $110 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $85 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $73 | $110 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $112 | $133 |
| Consultation office straightforward CPT 99241 • Office Visits | $83 | $83 | $83 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $115 | $152 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $192 | $278 |