| Obstetric ultrasound limited CPT 76815 • Maternity | $13 | $58 | $154 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $63 | $104 |
| Interactive complexity add-on CPT 90785 • Mental Health | $17 | $17 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $122 | $143 | $166 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $138 | $160 | $183 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $58 | $78 | $88 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $73 | $93 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $95 | $100 | $107 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $103 | $114 | $137 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $113 | $134 | $160 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $135 | $151 | $158 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $165 | $166 | $168 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $67 | $72 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $116 | $127 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $128 | $132 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $47 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $2 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $28 | $159 | $266 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $139 | $214 | $256 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $170 | $254 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $323 | $326 | $331 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $50 | $297 | $470 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $21 | $63 | $107 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $107 | $151 |
| EMG needle each extremity complete CPT 95886 • Neurology | $55 | $75 | $92 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $55 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $101 | $135 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $56 | $74 | $98 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $168 | $231 | $311 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $178 | $218 | $259 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $53 | $87 | $131 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $29 | $106 | $186 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $124 | $246 | $296 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $42 | $169 | $297 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $20 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $53 | $78 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $84 | $130 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $129 | $157 | $227 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $106 | $175 | $253 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $108 | $179 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $96 | $184 | $242 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $238 | $355 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $82 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $86 | $127 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $93 | $125 | $183 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $104 | $128 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $125 | $188 |
| Consultation office straightforward CPT 99241 • Office Visits | $75 | $75 | $75 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $96 | $215 |
| Consultation office high complexity CPT 99245 • Office Visits | $269 | $293 | $339 |