| Obstetric ultrasound limited CPT 76815 • Maternity | $33 | $38 | $41 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $17 | $40 | $63 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $138 | $148 | $165 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $149 | $162 | $169 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $66 | $75 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $68 | $75 | $85 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $88 | $94 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $86 | $99 | $120 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $132 | $142 | $147 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $104 | $118 | $138 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $156 | $165 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $63 | $66 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $105 | $110 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $123 | $130 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $33 | $41 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $3 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $10 | $100 | $160 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $96 | $125 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $18 | $81 | $123 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $59 | $186 | $273 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $61 | $235 | $338 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $39 | $58 | $83 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $49 | $84 | $121 |
| EMG needle each extremity complete CPT 95886 • Neurology | $43 | $56 | $81 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $40 | $61 | $87 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $66 | $108 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $59 | $100 | $141 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $76 | $118 | $170 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $111 | $195 | $278 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $40 | $66 | $82 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $9 | $68 | $116 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $41 | $83 | $167 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $41 | $134 | $189 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $16 | $25 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $3 | $32 | $49 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $6 | $46 | $81 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $41 | $69 | $85 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $57 | $120 | $157 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $8 | $90 | $159 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $41 | $114 | $159 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $79 | $167 | $214 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $16 | $44 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $9 | $53 | $76 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $41 | $86 | $110 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $41 | $64 | $77 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $112 | $114 |
| Consultation office straightforward CPT 99241 • Office Visits | $34 | $34 | $34 |
| Consultation office low complexity CPT 99243 • Office Visits | $11 | $60 | $126 |
| Consultation office high complexity CPT 99245 • Office Visits | $41 | $171 | $241 |