| Obstetric ultrasound complete CPT 76805 • Maternity | $54 | $147 | $346 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $115 | $339 | $474 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $80 | $145 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $81 | $112 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $19 | $37 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $289 | $434 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $101 | $277 | $488 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $44 | $128 | $205 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $106 | $189 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $170 | $271 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $35 | $152 | $240 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $249 | $401 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $61 | $218 | $319 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $113 | $275 | $386 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $135 | $189 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $193 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $215 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $59 | $73 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $9 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $248 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $168 | $288 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $142 | $273 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $321 | $868 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $140 | $357 | $826 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $140 | $284 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $230 | $411 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $149 | $240 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $118 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $155 | $282 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $74 | $210 | $345 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $70 | $215 | $444 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $176 | $404 | $725 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $48 | $96 | $184 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $80 | $157 | $285 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $122 | $253 | $426 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $154 | $311 | $562 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $27 | $60 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $37 | $64 | $88 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $56 | $122 | $233 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $61 | $167 | $327 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $114 | $217 | $459 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $143 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $193 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $147 | $275 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $68 | $92 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $106 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $86 | $151 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $74 | $111 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $94 | $157 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $71 | $71 | $71 |