| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $58 | $86 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $101 | $149 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $14 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $116 | $127 | $146 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $130 | $230 | $315 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $53 | $81 | $122 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $82 | $111 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $96 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $83 | $90 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $113 | $129 | $157 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $141 | $157 | $187 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $123 | $143 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $57 | $61 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $85 | $107 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $89 | $102 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $31 | $41 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $65 | $114 | $164 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $92 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $104 | $124 | $135 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $246 | $249 | $252 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $271 | $284 | $297 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $84 | $104 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $99 | $133 | $149 |
| EMG needle each extremity complete CPT 95886 • Neurology | $78 | $118 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $34 | $69 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $46 | $140 | $187 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $57 | $57 | $57 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $98 | $151 | $203 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $96 | $215 | $333 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $27 | $50 | $66 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $85 | $90 | $93 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $102 | $128 | $151 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $169 | $196 | $225 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $23 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $38 | $49 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $43 | $66 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $92 | $109 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $120 | $178 | $230 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $46 | $96 | $171 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $121 | $152 | $171 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $220 | $311 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $69 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $58 | $89 | $130 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $108 | $130 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $61 | $94 | $130 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $67 | $117 | $165 |
| Consultation office straightforward CPT 99241 • Office Visits | $39 | $39 | $39 |
| Consultation office low complexity CPT 99243 • Office Visits | $93 | $126 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $132 | $273 | $343 |