| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $50 | $57 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $25 | $38 | $56 |
| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $9 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $197 | $244 | $306 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $124 | $214 | $306 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $103 | $144 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $70 | $106 | $150 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $69 | $137 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $91 | $102 | $123 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $176 | $217 | $282 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $90 | $119 | $162 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $149 | $198 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $70 | $94 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $91 | $150 | $206 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $163 | $240 |
| Group psychotherapy CPT 90853 • Mental Health | $39 | $45 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $8 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $69 | $152 | $252 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $115 | $215 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $117 | $135 | $170 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $46 | $248 | $413 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $115 | $309 | $483 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $78 | $97 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $71 | $150 | $240 |
| EMG needle each extremity complete CPT 95886 • Neurology | $63 | $69 | $72 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $43 | $59 | $77 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $50 | $73 | $99 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $54 | $69 | $85 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $70 | $128 | $156 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $47 | $148 | $236 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $91 | $105 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $129 | $166 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $55 | $197 | $272 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $88 | $238 | $370 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $18 | $37 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $38 | $60 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $31 | $90 | $159 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $113 | $185 | $263 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $121 | $166 | $205 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $13 | $102 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $48 | $147 | $198 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $185 | $253 | $292 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $54 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $65 | $108 | $161 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $94 | $167 | $243 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $72 | $104 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $14 | $88 | $154 |
| Consultation office straightforward CPT 99241 • Office Visits | $48 | $48 | $48 |
| Consultation office low complexity CPT 99243 • Office Visits | $73 | $125 | $178 |
| Consultation office high complexity CPT 99245 • Office Visits | $145 | $203 | $279 |