| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $39 | $48 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $99 | $134 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $15 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $143 | $163 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $168 | $176 | $193 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $76 | $87 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $90 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $92 | $117 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $87 | $97 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $173 | $196 | $219 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $140 | $168 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $202 | $253 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $73 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $112 | $125 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $116 | $141 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $44 | $50 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $8 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $170 | $242 | $314 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $133 | $236 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $132 | $170 | $244 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $73 | $307 | $595 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $426 | $552 | $678 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $117 | $130 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $105 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $73 | $85 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $95 | $164 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $78 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $88 | $111 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $91 | $200 | $332 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $295 | $315 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $76 | $79 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $117 | $124 | $130 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $13 | $111 | $176 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $32 | $127 | $221 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $52 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $65 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $115 | $121 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $149 | $156 | $162 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $96 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $153 | $156 | $159 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $213 | $221 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $77 | $111 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $72 | $111 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $15 | $80 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $73 | $111 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $122 | $136 |
| Consultation office straightforward CPT 99241 • Office Visits | $77 | $77 | $77 |
| Consultation office low complexity CPT 99243 • Office Visits | $93 | $124 | $165 |
| Consultation office high complexity CPT 99245 • Office Visits | $184 | $226 | $285 |