| Obstetric ultrasound limited CPT 76815 • Maternity | $60 | $60 | $60 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $49 | $171 | $379 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $18 | $22 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $183 | $338 | $615 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $363 | $708 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $66 | $83 | $99 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $68 | $77 | $86 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $89 | $99 | $110 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $107 | $119 | $131 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $132 | $166 | $199 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $148 | $173 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $173 | $208 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $73 | $77 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $80 | $117 | $154 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $111 | $139 | $167 |
| Group psychotherapy CPT 90853 • Mental Health | $33 | $46 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $10 | $11 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $137 | $244 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $164 | $164 | $164 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $130 | $154 | $179 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $388 | $418 | $448 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $461 | $499 | $537 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $80 | $112 | $143 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $140 | $156 | $163 |
| EMG needle each extremity complete CPT 95886 • Neurology | $55 | $89 | $123 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $109 | $112 | $115 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $90 | $116 | $145 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $162 | $351 | $539 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $213 | $221 | $229 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $175 | $272 | $370 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $78 | $83 | $88 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $127 | $127 | $127 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $259 | $493 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $249 | $425 | $669 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $19 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $61 | $68 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $89 | $101 | $113 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $142 | $286 | $358 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $160 | $168 | $177 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $94 | $111 | $127 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $157 | $165 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $245 | $430 | $731 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $57 | $64 | $72 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $87 | $89 | $90 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $125 | $143 | $162 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $87 | $89 | $92 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $129 | $227 | $422 |
| Consultation office straightforward CPT 99241 • Office Visits | $35 | $35 | $35 |
| Consultation office low complexity CPT 99243 • Office Visits | $48 | $105 | $139 |
| Consultation office high complexity CPT 99245 • Office Visits | $228 | $263 | $294 |