| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $76 | $160 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $80 | $109 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $21 | $28 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $200 | $254 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $162 | $200 | $284 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $78 | $93 | $124 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $76 | $95 | $127 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $129 | $138 | $164 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $98 | $130 | $161 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $184 | $217 | $247 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $175 | $212 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $173 | $256 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $96 | $110 | $123 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $176 | $199 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $182 | $207 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $57 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $9 | $9 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $153 | $390 | $475 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $243 | $475 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $398 | $670 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $111 | $417 | $595 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $648 | $668 | $678 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $164 | $207 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $234 | $325 |
| EMG needle each extremity complete CPT 95886 • Neurology | $89 | $132 | $154 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $130 | $164 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $166 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $124 | $169 | $250 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $303 | $371 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $462 | $561 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $106 | $126 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $165 | $171 | $183 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $210 | $253 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $220 | $351 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $31 | $33 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $61 | $73 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $73 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $102 | $182 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $170 | $246 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $130 | $174 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $213 | $220 | $235 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $294 | $348 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $67 | $108 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $103 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $117 | $179 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $103 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $129 | $143 | $184 |
| Consultation office straightforward CPT 99241 • Office Visits | $77 | $77 | $77 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $144 | $211 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $334 | $384 |