| Obstetric ultrasound limited CPT 76815 • Maternity | $41 | $88 | $229 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $57 | $111 | $258 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $21 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $207 | $337 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $166 | $244 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $45 | $82 | $163 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $92 | $111 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $66 | $144 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $127 | $160 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $76 | $203 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $110 | $217 | $277 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $165 | $222 | $336 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $121 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $210 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $130 | $199 | $271 |
| Group psychotherapy CPT 90853 • Mental Health | $67 | $72 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $41 | $198 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $129 | $393 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $108 | $180 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $303 | $412 | $706 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $358 | $562 | $971 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $90 | $113 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $141 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $95 | $138 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $131 | $168 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $126 | $137 | $167 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $69 | $139 | $200 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $176 | $190 | $199 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $277 | $305 | $326 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $41 | $70 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $38 | $77 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $41 | $142 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $41 | $114 | $334 |
| Office visit established patient minimal CPT 99211 • Office Visits | $25 | $32 | $41 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $41 | $52 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $41 | $75 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $41 | $70 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $41 | $100 | $219 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $41 | $81 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $41 | $118 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $41 | $161 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $41 | $53 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $41 | $84 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $41 | $82 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $41 | $66 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $91 | $132 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $71 | $71 | $71 |
| Consultation office low complexity CPT 99243 • Office Visits | $41 | $129 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $41 | $239 | $445 |