| Obstetric ultrasound limited CPT 76815 • Maternity | $20 | $44 | $69 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $26 | $47 | $78 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $13 | $20 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $107 | $146 | $179 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $134 | $156 | $180 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $53 | $66 | $80 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $68 | $77 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $79 | $105 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $105 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $112 | $127 | $150 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $101 | $124 | $136 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $123 | $150 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $65 | $75 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $87 | $107 | $117 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $89 | $100 | $121 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $42 | $52 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $2 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $46 | $70 | $111 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $86 | $108 | $129 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $11 | $72 | $117 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $43 | $212 | $297 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $94 | $264 | $351 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $44 | $53 | $61 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $70 | $107 | $170 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $68 | $80 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $19 | $41 | $71 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $43 | $73 | $88 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $69 | $112 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $92 | $138 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $101 | $193 | $252 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $54 | $82 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $63 | $93 | $116 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $44 | $110 | $150 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $15 | $112 | $179 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $17 | $25 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $4 | $25 | $50 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $10 | $51 | $81 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $8 | $39 | $66 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $15 | $98 | $157 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $12 | $80 | $144 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $30 | $98 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $170 | $201 | $217 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $15 | $47 | $92 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $44 | $66 | $95 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $82 | $94 | $112 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $10 | $55 | $92 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $87 | $97 | $116 |
| Consultation office straightforward CPT 99241 • Office Visits | $28 | $28 | $28 |
| Consultation office low complexity CPT 99243 • Office Visits | $103 | $112 | $122 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $145 | $242 |