| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $138 | $232 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $84 | $94 | $104 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $23 | $45 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $125 | $288 | $595 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $161 | $338 | $666 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $55 | $129 | $258 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $108 | $212 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $160 | $302 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $153 | $299 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $107 | $224 | $444 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $86 | $198 | $395 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $136 | $234 | $428 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $113 | $213 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $92 | $171 | $327 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $83 | $174 | $341 |
| Group psychotherapy CPT 90853 • Mental Health | $17 | $43 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $8 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $92 | $219 | $441 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $88 | $271 | $453 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $49 | $208 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $70 | $203 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $204 | $690 | $1,459 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $52 | $109 | $169 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $74 | $165 | $271 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $169 | $325 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $97 | $123 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $43 | $173 | $373 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $51 | $249 | $448 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $66 | $155 | $235 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $175 | $355 | $622 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $5 | $73 | $164 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $44 | $104 | $189 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $81 | $262 | $378 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $130 | $354 | $499 |
| Office visit established patient minimal CPT 99211 • Office Visits | $5 | $19 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $34 | $63 | $114 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $32 | $77 | $134 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $46 | $132 | $258 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $103 | $198 | $362 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $93 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $9 | $133 | $297 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $94 | $205 | $397 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $18 | $55 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $43 | $94 | $181 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $9 | $122 | $272 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $58 | $100 | $184 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $8 | $117 | $261 |
| Consultation office straightforward CPT 99241 • Office Visits | $80 | $80 | $80 |
| Consultation office low complexity CPT 99243 • Office Visits | $10 | $203 | $341 |
| Consultation office high complexity CPT 99245 • Office Visits | $81 | $251 | $484 |