| Obstetric ultrasound limited CPT 76815 • Maternity | $20 | $60 | $101 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $22 | $66 | $115 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $101 | $145 | $211 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $134 | $175 | $275 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $45 | $53 | $71 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $71 | $85 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $66 | $93 | $138 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $64 | $89 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $87 | $123 | $145 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $104 | $125 | $138 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $133 | $154 | $165 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $79 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $122 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $72 | $116 | $130 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $54 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $96 | $123 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $121 | $140 | $147 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $108 | $110 | $113 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $59 | $200 | $320 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $358 | $386 | $441 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $98 | $104 | $123 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $91 | $129 | $141 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $105 | $141 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $42 | $62 | $102 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $55 | $106 | $126 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $66 | $154 | $201 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $148 | $188 | $199 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $116 | $326 | $432 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $53 | $73 | $80 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $42 | $90 | $157 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $42 | $135 | $257 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $38 | $161 | $254 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $28 | $38 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $46 | $48 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $42 | $67 | $140 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $38 | $97 | $197 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $99 | $148 | $184 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $42 | $91 | $159 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $42 | $107 | $186 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $42 | $127 | $206 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $36 | $45 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $58 | $106 | $182 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $93 | $118 | $181 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $67 | $74 | $76 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $98 | $120 | $175 |
| Consultation office straightforward CPT 99241 • Office Visits | $34 | $34 | $34 |
| Consultation office low complexity CPT 99243 • Office Visits | $105 | $115 | $126 |
| Consultation office high complexity CPT 99245 • Office Visits | $197 | $226 | $236 |