| Obstetric ultrasound limited CPT 76815 • Maternity | $44 | $97 | $160 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $47 | $88 | $128 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $13 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $184 | $257 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $186 | $212 | $225 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $72 | $84 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $76 | $79 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $86 | $108 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $91 | $103 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $112 | $178 | $246 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $133 | $156 | $186 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $162 | $205 | $248 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $68 | $106 | $144 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $106 | $130 | $144 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $128 | $162 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $32 | $51 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $8 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $158 | $237 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $171 | $195 | $256 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $202 | $233 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $258 | $362 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $310 | $430 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $69 | $89 | $128 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $37 | $129 | $184 |
| EMG needle each extremity complete CPT 95886 • Neurology | $111 | $130 | $152 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $41 | $52 | $62 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $104 | $148 | $199 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $116 | $170 | $224 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $121 | $183 | $291 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $215 | $358 | $445 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $73 | $84 | $100 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $114 | $138 | $157 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $21 | $136 | $223 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $168 | $233 | $306 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $27 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $57 | $60 | $63 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $69 | $88 | $105 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $128 | $188 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $116 | $177 | $235 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $85 | $126 | $153 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $134 | $155 | $189 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $152 | $246 | $347 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $51 | $60 | $68 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $81 | $105 | $124 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $122 | $141 | $158 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $82 | $96 | $108 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $100 | $130 | $159 |
| Consultation office straightforward CPT 99241 • Office Visits | $60 | $60 | $60 |
| Consultation office low complexity CPT 99243 • Office Visits | $81 | $150 | $201 |
| Consultation office high complexity CPT 99245 • Office Visits | $193 | $244 | $308 |