| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $33 | $37 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $38 | $62 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $14 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $102 | $160 | $230 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $144 | $163 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $72 | $113 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $50 | $74 | $116 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $105 | $150 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $95 | $147 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $123 | $130 | $141 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $91 | $118 | $145 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $114 | $131 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $64 | $72 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $116 | $181 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $101 | $120 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $30 | $35 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $77 | $77 | $77 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $102 | $148 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $123 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $64 | $239 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $57 | $200 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $58 | $78 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $118 | $165 |
| EMG needle each extremity complete CPT 95886 • Neurology | $42 | $72 | $102 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $53 | $106 | $157 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $77 | $101 | $114 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $60 | $124 | $242 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $90 | $198 | $317 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $133 | $201 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $50 | $78 | $124 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $77 | $87 | $104 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $152 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $152 | $187 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $20 | $37 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $47 | $73 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $61 | $77 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $95 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $109 | $151 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $68 | $99 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $122 | $134 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $180 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $36 | $45 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $66 | $102 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $77 | $102 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $63 | $76 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $111 | $130 |
| Consultation office straightforward CPT 99241 • Office Visits | $32 | $32 | $32 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $93 | $129 |
| Consultation office high complexity CPT 99245 • Office Visits | $196 | $223 | $255 |