| Obstetric ultrasound limited CPT 76815 • Maternity | $44 | $135 | $215 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $47 | $147 | $258 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $18 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $175 | $314 | $405 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $166 | $256 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $65 | $130 | $178 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $92 | $116 | $183 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $129 | $195 | $253 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $153 | $194 | $231 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $246 | $314 | $374 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $151 | $229 | $278 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $318 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $147 | $162 | $176 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $106 | $205 | $259 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $225 | $270 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $53 | $65 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $10 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $321 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $15 | $222 | $308 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $264 | $336 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $603 | $968 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $762 | $1,129 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $120 | $174 | $271 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $174 | $189 | $220 |
| EMG needle each extremity complete CPT 95886 • Neurology | $131 | $195 | $229 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $99 | $157 | $215 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $94 | $192 | $287 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $112 | $260 | $345 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $259 | $319 | $421 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $412 | $525 | $686 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $102 | $134 | $173 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $182 | $240 | $269 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $123 | $305 | $412 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $163 | $318 | $422 |
| Office visit established patient minimal CPT 99211 • Office Visits | $31 | $49 | $58 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $88 | $137 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $69 | $143 | $219 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $95 | $134 | $200 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $198 | $283 | $431 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $137 | $176 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $189 | $254 | $302 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $145 | $353 | $512 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $53 | $81 | $114 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $99 | $142 | $184 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $143 | $227 | $275 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $100 | $144 | $190 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $77 | $176 | $268 |
| Consultation office straightforward CPT 99241 • Office Visits | $71 | $71 | $71 |
| Consultation office low complexity CPT 99243 • Office Visits | $10 | $174 | $311 |
| Consultation office high complexity CPT 99245 • Office Visits | $236 | $359 | $495 |