| Obstetric ultrasound limited CPT 76815 • Maternity | $11 | $31 | $51 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $24 | $35 | $58 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $18 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $96 | $144 | $230 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $106 | $159 | $247 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $68 | $83 | $113 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $87 | $99 | $109 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $90 | $117 | $150 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $121 | $147 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $106 | $147 | $197 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $83 | $98 | $106 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $127 | $194 | $235 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $55 | $62 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $86 | $139 | $181 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $78 | $144 | $188 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $44 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $25 | $83 | $141 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $120 | $126 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $132 | $151 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $39 | $65 | $90 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $168 | $408 | $648 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $34 | $62 | $89 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $64 | $87 | $99 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $67 | $114 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $62 | $86 | $106 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $93 | $134 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $52 | $119 | $242 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $169 | $187 | $211 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $128 | $211 | $340 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $96 | $124 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $40 | $82 | $125 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $241 | $316 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $158 | $182 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $11 | $17 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $45 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $56 | $78 | $102 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $60 | $89 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $105 | $157 | $203 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $146 | $172 | $198 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $106 | $122 | $152 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $24 | $214 | $393 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $52 | $69 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $40 | $78 | $115 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $28 | $42 | $56 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $118 | $148 | $208 |
| Consultation office straightforward CPT 99241 • Office Visits | $64 | $64 | $64 |
| Consultation office low complexity CPT 99243 • Office Visits | $16 | $78 | $124 |
| Consultation office high complexity CPT 99245 • Office Visits | $25 | $108 | $191 |