| Obstetric ultrasound limited CPT 76815 • Maternity | $38 | $60 | $88 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $57 | $142 | $250 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $15 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $141 | $215 | $339 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $166 | $227 | $350 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $45 | $86 | $142 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $88 | $120 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $100 | $148 | $233 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $195 | $242 | $290 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $97 | $219 | $342 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $133 | $195 | $315 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $165 | $322 | $478 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $208 | $228 | $248 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $249 | $302 | $356 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $130 | $188 | $303 |
| Group psychotherapy CPT 90853 • Mental Health | $82 | $83 | $84 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $14 | $16 | $19 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $140 | $273 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $147 | $280 | $388 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $108 | $180 | $324 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $155 | $265 | $320 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $155 | $256 | $358 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $98 | $98 | $98 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $73 | $119 | $141 |
| EMG needle each extremity complete CPT 95886 • Neurology | $95 | $103 | $110 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $102 | $181 | $324 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $126 | $194 | $328 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $151 | $267 | $393 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $199 | $305 | $518 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $326 | $394 | $530 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $42 | $90 | $167 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $139 | $247 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $86 | $203 | $351 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $38 | $218 | $447 |
| Office visit established patient minimal CPT 99211 • Office Visits | $38 | $43 | $54 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $37 | $61 | $97 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $82 | $136 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $38 | $122 | $213 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $170 | $309 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $131 | $155 | $175 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $131 | $211 | $291 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $135 | $231 | $407 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $87 | $94 | $100 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $75 | $106 | $144 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $100 | $138 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $76 | $120 | $183 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $148 | $250 |
| Consultation office straightforward CPT 99241 • Office Visits | $88 | $88 | $88 |
| Consultation office low complexity CPT 99243 • Office Visits | $140 | $262 | $406 |
| Consultation office high complexity CPT 99245 • Office Visits | $214 | $333 | $572 |