| Obstetric ultrasound limited CPT 76815 • Maternity | $28 | $69 | $106 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $32 | $99 | $202 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $13 | $29 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $163 | $259 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $93 | $180 | $324 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $53 | $89 | $143 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $70 | $103 | $134 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $68 | $109 | $190 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $98 | $134 | $186 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $79 | $187 | $285 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $90 | $170 | $244 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $93 | $202 | $298 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $47 | $90 | $129 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $91 | $130 | $208 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $69 | $146 | $216 |
| Group psychotherapy CPT 90853 • Mental Health | $48 | $51 | $57 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $14 | $196 | $310 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $152 | $298 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $52 | $206 | $295 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $46 | $242 | $560 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $119 | $399 | $650 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $56 | $110 | $166 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $67 | $183 | $343 |
| EMG needle each extremity complete CPT 95886 • Neurology | $53 | $131 | $194 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $34 | $120 | $192 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $105 | $128 | $166 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $82 | $109 | $126 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $78 | $167 | $261 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $118 | $311 | $426 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $104 | $135 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $96 | $133 | $167 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $45 | $153 | $293 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $45 | $171 | $305 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $23 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $73 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $111 | $135 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $66 | $117 | $194 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $61 | $196 | $267 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $13 | $107 | $184 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $152 | $199 | $248 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $180 | $269 | $365 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $61 | $74 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $87 | $112 | $131 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $71 | $146 | $188 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $87 | $113 | $131 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $73 | $146 | $193 |
| Consultation office straightforward CPT 99241 • Office Visits | $45 | $45 | $45 |
| Consultation office low complexity CPT 99243 • Office Visits | $45 | $130 | $221 |
| Consultation office high complexity CPT 99245 • Office Visits | $273 | $332 | $405 |