| Obstetric ultrasound limited CPT 76815 • Maternity | $49 | $78 | $113 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $31 | $82 | $164 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $9 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $55 | $162 | $285 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $55 | $166 | $238 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $35 | $76 | $119 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $79 | $127 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $45 | $87 | $154 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $89 | $104 | $129 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $113 | $162 | $249 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $59 | $139 | $208 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $181 | $260 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $99 | $125 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $106 | $120 | $145 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $141 | $208 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $38 | $48 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $9 | $9 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $96 | $130 | $176 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $183 | $271 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $214 | $239 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $366 | $541 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $422 | $745 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $110 | $149 | $227 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $60 | $127 | $160 |
| EMG needle each extremity complete CPT 95886 • Neurology | $72 | $96 | $120 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $88 | $132 | $175 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $93 | $99 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $59 | $94 | $112 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $144 | $147 | $150 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $211 | $312 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $83 | $103 | $125 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $125 | $135 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $169 | $201 | $232 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $286 | $287 | $289 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $29 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $21 | $48 | $93 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $90 | $101 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $149 | $162 | $182 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $118 | $169 | $198 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $21 | $100 | $173 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $169 | $179 | $198 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $240 | $292 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $67 | $85 | $118 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $118 | $122 | $127 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $118 | $140 | $178 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $98 | $111 | $118 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $144 | $155 | $183 |
| Consultation office straightforward CPT 99241 • Office Visits | $79 | $79 | $79 |
| Consultation office low complexity CPT 99243 • Office Visits | $77 | $151 | $212 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $215 | $385 |