| Obstetric ultrasound limited CPT 76815 • Maternity | $58 | $119 | $196 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $32 | $119 | $223 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $18 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $129 | $181 | $238 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $153 | $229 | $306 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $57 | $83 | $105 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $83 | $108 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $73 | $102 | $157 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $98 | $117 | $137 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $165 | $230 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $102 | $134 | $164 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $163 | $231 | $308 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $88 | $98 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $72 | $106 | $151 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $86 | $119 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $29 | $42 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $99 | $136 | $164 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $34 | $237 | $364 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $59 | $147 | $246 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $132 | $252 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $333 | $670 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $90 | $92 | $94 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $65 | $107 | $131 |
| EMG needle each extremity complete CPT 95886 • Neurology | $53 | $73 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $21 | $88 | $138 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $69 | $100 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $81 | $84 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $203 | $298 | $421 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $137 | $303 | $440 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $95 | $116 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $83 | $121 | $172 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $220 | $264 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $174 | $243 | $338 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $15 | $17 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $50 | $87 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $53 | $89 | $139 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $104 | $187 | $307 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $38 | $137 | $276 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $67 | $91 | $128 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $107 | $208 | $315 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $120 | $183 | $269 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $32 | $73 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $58 | $124 | $192 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $83 | $122 | $185 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $58 | $83 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $43 | $102 | $177 |
| Consultation office straightforward CPT 99241 • Office Visits | $64 | $64 | $64 |
| Consultation office low complexity CPT 99243 • Office Visits | $73 | $143 | $181 |
| Consultation office high complexity CPT 99245 • Office Visits | $203 | $234 | $282 |