| Obstetric ultrasound limited CPT 76815 • Maternity | $72 | $127 | $182 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $79 | $118 | $196 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $10 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $143 | $169 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $191 | $192 | $194 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $78 | $85 | $92 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $72 | $87 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $103 | $116 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $98 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $152 | $168 | $184 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $121 | $132 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $146 | $148 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $84 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $105 | $112 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $126 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $47 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $63 | $147 | $230 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $125 | $205 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $173 | $236 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $366 | $380 | $394 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $242 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $63 | $95 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $79 | $134 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $96 | $96 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $64 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $60 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $77 | $77 | $77 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $103 | $194 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $47 | $58 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $174 | $237 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $135 | $139 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $370 | $465 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $55 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $115 | $191 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $96 | $158 | $270 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $143 | $261 | $379 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $119 | $176 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $129 | $203 | $277 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $171 | $304 | $370 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $49 | $77 | $106 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $78 | $138 | $169 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $117 | $167 | $254 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $80 | $95 | $110 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $110 | $118 | $130 |
| Consultation office straightforward CPT 99241 • Office Visits | $58 | $58 | $58 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $71 | $112 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $164 | $254 |