| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $55 | $81 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $56 | $95 | $149 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $11 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $126 | $167 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $208 | $315 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $63 | $85 | $122 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $64 | $80 | $111 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $114 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $87 | $98 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $125 | $155 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $134 | $187 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $130 | $131 | $131 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $63 | $80 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $102 | $127 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $116 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $46 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $153 | $153 | $154 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $96 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $121 | $146 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $343 | $367 | $380 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $335 | $388 | $440 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $113 | $114 | $117 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $162 | $163 | $165 |
| EMG needle each extremity complete CPT 95886 • Neurology | $42 | $100 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $39 | $73 | $91 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $48 | $140 | $187 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $60 | $91 | $136 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $178 | $181 | $186 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $288 | $290 | $291 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $85 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $104 | $139 | $174 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $154 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $200 | $213 | $222 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $28 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $61 | $87 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $81 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $103 | $202 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $140 | $185 | $230 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $95 | $157 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $134 | $173 | $211 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $244 | $311 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $34 | $39 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $44 | $71 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $54 | $102 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $71 | $112 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $105 | $135 | $165 |
| Consultation office straightforward CPT 99241 • Office Visits | $46 | $46 | $46 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $98 | $145 |
| Consultation office high complexity CPT 99245 • Office Visits | $218 | $282 | $343 |