| Obstetric ultrasound limited CPT 76815 • Maternity | $24 | $57 | $102 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $27 | $63 | $110 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $13 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $124 | $189 | $339 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $219 | $282 | $353 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $65 | $106 | $141 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $81 | $94 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $119 | $183 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $82 | $118 | $153 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $93 | $115 | $131 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $190 | $248 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $155 | $226 | $298 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $124 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $105 | $179 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $180 | $264 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $33 | $38 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $38 | $98 | $187 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $157 | $170 | $181 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $195 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $72 | $156 | $316 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $225 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $119 | $134 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $102 | $149 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $111 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $107 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $73 | $115 | $197 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $77 | $168 | $259 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $412 | $444 | $476 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $46 | $69 | $102 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $89 | $111 | $145 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $132 | $223 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $25 | $189 | $282 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $19 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $44 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $68 | $76 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $14 | $96 | $147 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $110 | $135 | $150 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $75 | $106 | $137 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $136 | $186 | $236 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $20 | $157 | $278 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $52 | $60 | $68 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $63 | $81 | $99 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $76 | $110 | $143 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $99 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $92 | $120 | $144 |
| Consultation office straightforward CPT 99241 • Office Visits | $71 | $71 | $71 |
| Consultation office low complexity CPT 99243 • Office Visits | $122 | $134 | $145 |
| Consultation office high complexity CPT 99245 • Office Visits | $38 | $184 | $260 |