| Obstetric ultrasound limited CPT 76815 • Maternity | $50 | $87 | $150 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $63 | $98 | $160 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $13 | $28 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $184 | $232 | $327 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $158 | $286 | $351 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $74 | $105 | $149 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $102 | $123 | $137 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $110 | $156 | $187 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $121 | $178 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $145 | $151 | $157 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $193 | $253 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $209 | $280 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $75 | $106 | $138 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $156 | $218 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $189 | $195 | $207 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $44 | $51 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $10 | $10 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $195 | $266 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $212 | $259 | $296 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $288 | $288 | $288 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $70 | $245 | $333 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $106 | $208 | $311 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $63 | $91 | $106 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $121 | $158 | $178 |
| EMG needle each extremity complete CPT 95886 • Neurology | $167 | $183 | $199 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $85 | $128 | $171 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $195 | $213 | $250 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $60 | $98 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $180 | $306 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $377 | $500 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $75 | $96 | $107 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $158 | $166 | $173 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $71 | $212 | $322 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $304 | $319 | $336 |
| Office visit established patient minimal CPT 99211 • Office Visits | $34 | $37 | $43 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $57 | $63 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $103 | $125 | $169 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $137 | $178 | $213 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $212 | $274 | $336 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $79 | $126 | $149 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $131 | $170 | $209 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $183 | $227 | $305 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $51 | $62 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $65 | $96 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $160 | $175 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $115 | $124 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $123 | $155 | $175 |
| Consultation office straightforward CPT 99241 • Office Visits | $40 | $40 | $40 |
| Consultation office low complexity CPT 99243 • Office Visits | $119 | $179 | $211 |
| Consultation office high complexity CPT 99245 • Office Visits | $93 | $269 | $380 |