| Obstetric ultrasound limited CPT 76815 • Maternity | $38 | $75 | $144 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $48 | $90 | $138 |
| Interactive complexity add-on CPT 90785 • Mental Health | $18 | $20 | $24 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $166 | $190 | $228 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $146 | $225 | $350 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $59 | $91 | $111 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $82 | $98 | $115 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $106 | $126 | $148 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $111 | $124 | $145 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $119 | $168 | $202 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $154 | $192 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $142 | $172 | $201 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $94 | $101 | $111 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $137 | $175 | $245 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $132 | $151 | $185 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $44 | $69 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $7 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $97 | $149 | $218 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $44 | $163 | $257 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $130 | $177 | $215 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $70 | $386 | $604 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $83 | $367 | $517 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $56 | $155 | $284 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $106 | $155 | $179 |
| EMG needle each extremity complete CPT 95886 • Neurology | $56 | $74 | $108 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $54 | $97 | $166 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $84 | $163 | $292 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $100 | $221 | $348 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $136 | $205 | $336 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $268 | $367 | $509 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $90 | $127 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $90 | $118 | $133 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $154 | $213 | $280 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $255 | $328 | $484 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $29 | $55 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $47 | $53 | $64 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $90 | $107 | $124 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $98 | $160 | $251 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $111 | $155 | $180 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $111 | $175 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $118 | $151 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $158 | $271 | $480 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $44 | $49 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $54 | $85 | $125 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $108 | $138 | $180 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $74 | $96 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $104 | $159 | $254 |
| Consultation office straightforward CPT 99241 • Office Visits | $83 | $83 | $83 |
| Consultation office low complexity CPT 99243 • Office Visits | $120 | $128 | $144 |
| Consultation office high complexity CPT 99245 • Office Visits | $223 | $304 | $525 |