| Obstetric ultrasound limited CPT 76815 • Maternity | $32 | $46 | $59 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $12 | $52 | $103 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $15 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $105 | $118 | $125 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $153 | $157 | $160 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $62 | $68 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $70 | $71 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $89 | $94 | $102 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $67 | $75 | $82 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $90 | $109 | $134 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $109 | $114 | $119 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $131 | $137 | $143 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $51 | $59 | $67 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $93 | $100 | $108 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $112 | $113 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $36 | $46 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $127 | $135 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $40 | $88 | $115 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $118 | $127 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $303 | $430 | $641 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $205 | $352 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $66 | $91 | $104 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $72 | $101 | $148 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $61 | $77 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $40 | $61 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $53 | $89 | $108 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $70 | $107 | $144 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $82 | $125 | $168 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $189 | $223 | $258 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $50 | $63 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $101 | $105 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $96 | $141 | $179 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $201 | $225 | $276 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $18 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $48 | $63 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $84 | $100 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $101 | $106 | $111 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $142 | $168 | $194 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $121 | $188 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $96 | $139 | $188 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $183 | $218 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $47 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $96 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $102 | $116 | $143 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $96 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $105 | $117 | $143 |
| Consultation office straightforward CPT 99241 • Office Visits | $32 | $32 | $32 |
| Consultation office low complexity CPT 99243 • Office Visits | $40 | $95 | $127 |
| Consultation office high complexity CPT 99245 • Office Visits | $188 | $233 | $280 |