| Obstetric ultrasound limited CPT 76815 • Maternity | $50 | $69 | $87 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $69 | $87 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $7 | $11 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $128 | $159 | $183 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $131 | $157 | $187 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $67 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $44 | $62 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $98 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $71 | $85 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $114 | $125 | $135 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $119 | $145 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $158 | $172 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $69 | $89 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $96 | $134 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $77 | $109 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $26 | $31 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $85 | $92 | $100 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $150 | $172 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $149 | $178 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $183 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $116 | $225 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $33 | $60 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $101 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $68 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $58 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $68 | $103 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $61 | $87 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $79 | $153 | $203 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $116 | $176 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $42 | $60 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $64 | $84 | $103 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $101 | $135 | $169 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $132 | $155 | $180 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $11 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $40 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $54 | $64 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $104 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $92 | $130 | $186 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $81 | $97 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $110 | $115 | $121 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $96 | $144 | $169 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $35 | $39 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $65 | $69 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $84 | $91 | $100 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $10 | $52 | $75 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $87 | $113 | $143 |
| Consultation office straightforward CPT 99241 • Office Visits | $29 | $29 | $29 |
| Consultation office low complexity CPT 99243 • Office Visits | $85 | $97 | $117 |
| Consultation office high complexity CPT 99245 • Office Visits | $5 | $149 | $273 |