| Obstetric ultrasound limited CPT 76815 • Maternity | $84 | $94 | $113 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $58 | $126 | $258 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $17 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $111 | $170 | $327 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $126 | $237 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $62 | $106 | $162 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $49 | $102 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $81 | $142 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $61 | $118 | $209 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $90 | $166 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $82 | $187 | $277 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $99 | $245 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $43 | $85 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $75 | $133 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $78 | $178 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $33 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $11 | $180 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $104 | $240 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $48 | $234 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $396 | $851 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $51 | $378 | $971 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $100 | $166 | $296 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $70 | $138 | $203 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $104 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $40 | $85 | $134 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $41 | $106 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $49 | $89 | $145 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $64 | $139 | $187 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $259 | $302 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $4 | $76 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $9 | $121 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $64 | $171 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $69 | $206 | $334 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $13 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $20 | $43 | $60 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $10 | $67 | $101 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $49 | $126 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $14 | $158 | $281 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $53 | $113 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $98 | $157 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $66 | $219 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $6 | $41 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $9 | $85 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $76 | $128 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $52 | $89 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $13 | $114 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $78 | $163 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $124 | $255 | $445 |