| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $46 | $81 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $37 | $52 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $9 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $145 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $141 | $171 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $76 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $86 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $75 | $106 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $88 | $106 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $130 | $157 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $120 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $131 | $140 | $150 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $73 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $108 | $128 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $105 | $135 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $46 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $133 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $80 | $129 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $124 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $245 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $407 | $418 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $66 | $96 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $163 | $167 |
| EMG needle each extremity complete CPT 95886 • Neurology | $92 | $94 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $62 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $67 | $97 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $111 | $144 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $180 | $189 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $289 | $296 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $20 | $59 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $74 | $88 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $127 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $153 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $52 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $60 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $48 | $85 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $142 | $153 | $168 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $94 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $139 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $29 | $138 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $76 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $75 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $89 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $76 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $105 | $117 | $130 |
| Consultation office straightforward CPT 99241 • Office Visits | $44 | $44 | $44 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $51 | $94 |
| Consultation office high complexity CPT 99245 • Office Visits | $188 | $232 | $255 |