| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $46 | $65 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $75 | $95 | $128 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $17 | $33 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $255 | $344 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $186 | $274 | $353 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $65 | $124 | $152 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $92 | $112 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $86 | $154 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $162 | $218 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $131 | $204 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $151 | $231 | $286 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $318 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $128 | $167 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $183 | $261 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $221 | $264 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $60 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $202 | $333 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $228 | $281 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $264 | $305 | $345 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $109 | $139 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $113 | $145 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $138 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $242 | $403 |
| EMG needle each extremity complete CPT 95886 • Neurology | $129 | $177 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $95 | $95 | $95 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $102 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $112 | $145 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $147 | $301 | $454 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $412 | $565 | $717 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $106 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $155 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $185 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $216 | $313 | $441 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $36 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $50 | $56 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $69 | $89 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $92 | $124 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $228 | $310 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $139 | $176 | $218 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $160 | $209 | $295 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $288 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $89 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $97 | $127 | $155 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $129 | $171 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $127 | $138 | $156 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $162 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $168 | $194 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $346 | $482 |