| Obstetric ultrasound first trimester CPT 76801 • Maternity | $103 | $171 | $240 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $119 | $197 | $275 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $349 | $349 | $349 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $43 | $49 | $55 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $119 | $190 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $17 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $216 | $270 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $162 | $264 | $366 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $78 | $114 | $151 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $76 | $76 | $76 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $97 | $149 | $200 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $98 | $98 | $98 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $138 | $138 | $138 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $144 | $144 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $132 | $132 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $71 | $71 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $112 | $112 | $112 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $150 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $66 | $66 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $131 | $131 | $131 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $366 | $366 | $366 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $115 | $115 | $115 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $60 | $60 | $60 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $80 | $80 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $55 | $55 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $47 | $83 | $119 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $222 | $222 | $222 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $163 | $223 | $283 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $215 | $327 | $440 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $31 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $57 | $84 | $111 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $88 | $132 | $176 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $178 | $249 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $214 | $296 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $200 | $200 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $269 | $269 | $269 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $337 | $337 | $337 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $76 | $103 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $121 | $125 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $129 | $164 | $199 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $129 | $136 | $142 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $129 | $154 | $179 |
| Consultation office low complexity CPT 99243 • Office Visits | $170 | $170 | $170 |
| Consultation office high complexity CPT 99245 • Office Visits | $254 | $254 | $254 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $37 | $37 |