| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $63 | $113 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $51 | $84 | $120 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $13 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $138 | $209 | $339 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $137 | $220 | $283 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $72 | $119 | $141 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $92 | $103 | $127 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $83 | $131 | $183 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $130 | $153 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $122 | $130 | $138 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $86 | $181 | $248 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $317 | $336 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $96 | $147 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $105 | $146 | $217 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $180 | $264 |
| Group psychotherapy CPT 90853 • Mental Health | $33 | $48 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $96 | $122 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $139 | $271 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $213 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $246 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $92 | $104 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $114 | $116 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $142 | $175 | $235 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $86 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $161 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $107 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $147 | $260 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $150 | $222 | $341 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $232 | $310 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $83 | $102 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $104 | $112 | $121 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $162 | $202 | $292 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $179 | $252 | $352 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $28 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $28 | $50 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $70 | $101 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $94 | $135 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $227 | $259 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $111 | $178 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $180 | $185 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $287 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $29 | $71 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $100 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $119 | $179 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $90 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $79 | $131 | $184 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $106 | $168 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $289 | $308 |