| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $69 | $113 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $52 | $67 |
| Interactive complexity add-on CPT 90785 • Mental Health | $7 | $16 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $111 | $184 | $252 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $185 | $194 | $202 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $71 | $72 | $73 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $39 | $61 | $84 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $96 | $101 | $110 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $100 | $100 | $100 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $97 | $161 | $220 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $133 | $145 | $162 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $248 | $248 | $248 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $128 | $128 | $128 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $105 | $114 | $122 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $142 | $164 | $185 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $35 | $42 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $8 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $106 | $188 | $271 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $111 | $163 | $215 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $169 | $190 | $210 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $100 | $215 | $331 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $221 | $362 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $69 | $69 | $69 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $58 | $100 | $142 |
| EMG needle each extremity complete CPT 95886 • Neurology | $70 | $75 | $80 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $62 | $62 | $62 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $164 | $168 | $172 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $116 | $127 | $139 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $154 | $243 | $332 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $171 | $248 | $325 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $51 | $75 | $112 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $93 | $143 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $145 | $280 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $184 | $360 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $30 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $37 | $44 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $64 | $123 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $93 | $147 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $141 | $247 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $66 | $119 | $174 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $131 | $170 | $236 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $135 | $199 | $301 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $47 | $54 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $55 | $82 | $100 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $90 | $110 | $140 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $69 | $92 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $112 | $147 |
| Consultation office straightforward CPT 99241 • Office Visits | $37 | $37 | $37 |
| Consultation office low complexity CPT 99243 • Office Visits | $90 | $132 | $170 |
| Consultation office high complexity CPT 99245 • Office Visits | $214 | $254 | $338 |