| Obstetric ultrasound limited CPT 76815 • Maternity | $70 | $137 | $229 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $32 | $119 | $258 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $18 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $129 | $200 | $327 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $194 | $263 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $50 | $104 | $163 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $101 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $66 | $110 | $216 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $67 | $118 | $209 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $97 | $171 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $116 | $196 | $277 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $94 | $244 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $91 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $72 | $130 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $183 | $271 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $35 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $7 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $17 | $115 | $259 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $79 | $232 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $14 | $212 | $345 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $362 | $706 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $321 | $826 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $105 | $125 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $74 | $149 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $136 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $17 | $67 | $99 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $43 | $141 | $287 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $64 | $154 | $200 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $108 | $274 | $454 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $55 | $407 | $753 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $29 | $91 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $66 | $107 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $94 | $213 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $13 | $237 | $403 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $27 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $12 | $41 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $7 | $70 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $58 | $102 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $75 | $149 | $219 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $50 | $129 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $78 | $169 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $122 | $275 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $26 | $53 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $42 | $104 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $42 | $142 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $57 | $100 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $146 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $14 | $129 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $27 | $258 | $445 |