| Obstetric ultrasound limited CPT 76815 • Maternity | $45 | $50 | $55 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $90 | $165 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $22 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $123 | $194 | $311 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $152 | $303 | $400 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $72 | $114 | $156 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $75 | $109 | $143 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $89 | $127 | $165 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $88 | $125 | $162 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $144 | $222 | $300 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $125 | $181 | $237 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $219 | $289 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $102 | $132 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $89 | $102 | $116 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $163 | $205 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $36 | $46 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $8 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $84 | $84 | $84 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $145 | $245 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $144 | $144 | $144 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $326 | $326 | $326 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $457 | $457 | $457 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $56 | $72 | $88 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $89 | $105 | $128 |
| EMG needle each extremity complete CPT 95886 • Neurology | $101 | $101 | $101 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $60 | $135 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $87 | $87 | $87 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $92 | $92 | $92 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $121 | $121 | $121 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $54 | $54 | $54 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $115 | $115 | $115 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $175 | $243 | $311 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $220 | $285 | $413 |
| Office visit established patient minimal CPT 99211 • Office Visits | $24 | $24 | $24 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $48 | $48 | $48 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $79 | $90 | $100 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $8 | $121 | $239 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $155 | $155 | $155 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $108 | $108 | $108 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $146 | $146 | $146 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $216 | $244 | $271 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $42 | $42 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $78 | $78 | $78 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $111 | $111 | $111 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $78 | $78 | $78 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $114 | $150 | $186 |
| Consultation office straightforward CPT 99241 • Office Visits | $68 | $68 | $68 |
| Consultation office low complexity CPT 99243 • Office Visits | $121 | $126 | $131 |
| Consultation office high complexity CPT 99245 • Office Visits | $238 | $240 | $242 |