| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $62 | $91 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $82 | $90 | $102 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $11 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $102 | $155 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $152 | $162 | $179 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $76 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $67 | $85 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $91 | $110 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $102 | $129 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $139 | $144 | $149 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $123 | $141 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $134 | $172 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $75 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $121 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $121 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $29 | $37 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $101 | $101 | $101 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $100 | $169 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $356 | $360 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $399 | $419 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $45 | $78 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $120 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $79 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $56 | $70 | $85 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $155 | $175 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $95 | $135 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $140 | $213 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $78 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $123 | $134 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $66 | $126 | $156 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $162 | $215 | $258 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $20 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $55 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $64 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $70 | $100 | $136 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $121 | $129 | $137 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $74 | $128 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $121 | $124 | $128 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $19 | $116 | $178 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $44 | $50 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $71 | $91 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $115 | $132 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $61 | $80 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $103 | $109 |
| Consultation office straightforward CPT 99241 • Office Visits | $58 | $58 | $58 |
| Consultation office low complexity CPT 99243 • Office Visits | $117 | $137 | $157 |
| Consultation office high complexity CPT 99245 • Office Visits | $213 | $249 | $285 |