| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $36 | $48 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $43 | $63 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $9 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $157 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $181 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $77 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $87 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $97 | $119 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $96 | $109 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $100 | $141 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $137 | $142 | $145 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $151 | $152 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $82 | $91 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $118 | $138 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $116 | $139 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $53 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $109 | $188 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $134 | $191 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $138 | $147 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $63 | $289 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $63 | $246 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $119 | $135 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $96 | $139 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $56 | $77 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $72 | $108 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $90 | $137 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $69 | $105 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $91 | $147 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $305 | $344 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $76 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $112 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $235 | $407 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $245 | $539 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $23 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $48 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $64 | $90 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $10 | $63 | $131 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $142 | $167 | $184 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $103 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $121 | $146 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $29 | $152 | $219 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $65 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $72 | $110 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $89 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $73 | $110 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $101 | $116 | $131 |
| Consultation office straightforward CPT 99241 • Office Visits | $49 | $49 | $49 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $108 | $150 |
| Consultation office high complexity CPT 99245 • Office Visits | $254 | $261 | $274 |