| Obstetric ultrasound limited CPT 76815 • Maternity | $24 | $54 | $83 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $65 | $83 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $10 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $124 | $157 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $156 | $172 | $205 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $77 | $84 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $60 | $74 | $87 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $103 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $68 | $83 | $98 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $143 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $118 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $129 | $154 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $74 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $104 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $111 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $48 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $128 | $139 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $98 | $134 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $69 | $260 | $311 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $409 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $67 | $100 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $122 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $50 | $65 | $104 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $41 | $48 | $52 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $117 | $131 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $124 | $150 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $82 | $117 | $177 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $112 | $250 | $318 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $47 | $59 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $106 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $81 | $149 | $189 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $166 | $273 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $22 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $46 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $58 | $65 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $95 | $131 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $110 | $154 | $185 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $114 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $131 | $143 | $169 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $164 | $230 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $77 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $107 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $92 | $100 | $110 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $95 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $101 | $114 | $143 |
| Consultation office straightforward CPT 99241 • Office Visits | $53 | $53 | $53 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $110 | $170 |
| Consultation office high complexity CPT 99245 • Office Visits | $191 | $207 | $213 |