| Obstetric ultrasound limited CPT 76815 • Maternity | $35 | $55 | $85 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $39 | $98 | $159 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $16 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $93 | $178 | $337 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $124 | $239 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $60 | $108 | $163 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $60 | $102 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $68 | $121 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $91 | $131 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $79 | $153 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $151 | $229 | $277 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $106 | $247 | $336 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $124 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $69 | $128 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $78 | $179 | $271 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $53 | $73 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $6 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $68 | $216 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $11 | $240 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $82 | $235 | $345 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $57 | $142 | $285 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $179 | $328 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $89 | $130 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $71 | $139 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $99 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $16 | $108 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $46 | $149 | $287 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $119 | $172 | $200 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $31 | $130 | $187 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $236 | $410 | $753 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $4 | $69 | $102 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $7 | $102 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $21 | $192 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $152 | $260 | $403 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $28 | $45 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $2 | $38 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $4 | $78 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $89 | $134 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $140 | $174 | $219 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $43 | $132 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $116 | $181 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $45 | $246 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $65 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $9 | $79 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $127 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $64 | $93 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $9 | $116 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $124 | $153 | $194 |
| Consultation office high complexity CPT 99245 • Office Visits | $14 | $202 | $382 |