| Obstetric ultrasound complete CPT 76805 • Maternity | $47 | $125 | $201 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $85 | $212 | $407 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $26 | $82 | $192 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $97 | $220 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $19 | $49 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $96 | $173 | $252 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $206 | $342 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $55 | $84 | $108 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $23 | $85 | $112 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $88 | $110 | $144 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $103 | $144 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $88 | $156 | $232 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $46 | $124 | $176 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $99 | $148 | $225 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $42 | $95 | $222 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $55 | $102 | $174 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $68 | $107 | $181 |
| Group psychotherapy CPT 90853 • Mental Health | $19 | $37 | $68 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $151 | $319 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $92 | $162 | $341 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $71 | $155 | $349 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $399 | $752 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $43 | $430 | $877 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $39 | $96 | $284 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $78 | $159 | $289 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $94 | $160 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $97 | $223 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $42 | $98 | $181 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $113 | $218 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $160 | $322 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $77 | $256 | $524 |
| EEG monitoring continuous 24 hours CPT 95950 • Neurology | $164 | $164 | $164 |
| EEG monitoring continuous 24 hours with video CPT 95951 • Neurology | $3,397 | $3,397 | $3,397 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $119 | $350 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $65 | $147 | $350 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $108 | $210 | $365 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $144 | $250 | $458 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $53 | $250 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $78 | $250 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $45 | $115 | $250 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $61 | $136 | $250 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $89 | $210 | $322 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $66 | $113 | $247 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $85 | $159 | $302 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $147 | $245 | $446 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $68 | $165 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $60 | $94 | $165 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $78 | $130 | $229 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $48 | $93 | $165 |