| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $40 | $59 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $74 | $94 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $155 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $132 | $169 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $70 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $70 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $87 | $91 | $97 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $74 | $86 | $98 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $90 | $134 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $131 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $164 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $86 | $92 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $83 | $105 | $127 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $103 | $126 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $44 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $133 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $114 | $129 | $140 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $128 | $133 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $183 | $230 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $149 | $289 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $100 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $81 | $117 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $69 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $56 | $73 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $68 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $64 | $64 | $64 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $112 | $144 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $303 | $321 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $72 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $86 | $102 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $13 | $110 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $18 | $110 | $225 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $22 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $49 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $57 | $72 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $48 | $97 | $129 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $116 | $129 | $149 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $110 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $96 | $126 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $180 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $70 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $88 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $107 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $89 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $107 | $129 |
| Consultation office straightforward CPT 99241 • Office Visits | $45 | $45 | $45 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $106 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $211 | $240 | $255 |