| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $74 | $100 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $70 | $91 | $109 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $17 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $166 | $238 | $335 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $152 | $213 | $331 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $99 | $164 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $112 | $168 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $91 | $135 | $198 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $82 | $132 | $195 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $150 | $238 | $326 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $101 | $163 | $279 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $118 | $214 | $309 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $109 | $163 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $100 | $163 | $240 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $158 | $249 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $40 | $59 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $191 | $236 | $326 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $163 | $276 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $222 | $311 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $526 | $685 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $136 | $257 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $117 | $123 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $178 | $195 |
| EMG needle each extremity complete CPT 95886 • Neurology | $114 | $114 | $114 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $91 | $92 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $195 | $279 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $139 | $144 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $180 | $185 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $365 | $446 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $102 | $169 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $181 | $250 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $238 | $383 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $225 | $282 | $374 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $33 | $47 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $70 | $100 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $97 | $175 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $124 | $175 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $164 | $205 | $246 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $110 | $234 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $103 | $210 | $317 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $272 | $467 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $65 | $91 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $86 | $167 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $138 | $241 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $91 | $168 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $173 | $246 |
| Consultation office straightforward CPT 99241 • Office Visits | $88 | $88 | $88 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $127 | $224 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $386 | $518 |