| Obstetric ultrasound limited CPT 76815 • Maternity | $25 | $58 | $85 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $17 | $101 | $159 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $19 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $129 | $202 | $337 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $171 | $250 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $65 | $110 | $162 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $84 | $109 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $119 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $86 | $129 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $111 | $182 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $102 | $196 | $278 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $123 | $253 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $101 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $135 | $261 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $187 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $41 | $65 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $7 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $16 | $127 | $259 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $21 | $243 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $83 | $210 | $345 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $327 | $851 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $348 | $826 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $146 | $296 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $85 | $209 | $411 |
| EMG needle each extremity complete CPT 95886 • Neurology | $50 | $82 | $117 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $50 | $129 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $69 | $103 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $31 | $143 | $200 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $93 | $252 | $454 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $137 | $409 | $753 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $4 | $73 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $13 | $113 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $96 | $214 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $80 | $239 | $403 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $23 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $28 | $51 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $8 | $73 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $5 | $85 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $76 | $163 | $281 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $39 | $114 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $91 | $157 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $134 | $241 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $16 | $43 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $50 | $87 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $42 | $118 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $58 | $90 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $13 | $113 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $51 | $51 | $51 |
| Consultation office low complexity CPT 99243 • Office Visits | $96 | $142 | $194 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $266 | $445 |