| Obstetric ultrasound limited CPT 76815 • Maternity | $75 | $99 | $124 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $79 | $129 | $179 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $23 | $31 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $140 | $200 | $233 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $164 | $221 | $319 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $83 | $97 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $39 | $55 | $72 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $117 | $121 | $125 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $86 | $127 | $167 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $164 | $169 | $173 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $142 | $191 | $240 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $164 | $209 | $253 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $101 | $131 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $80 | $92 | $105 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $98 | $110 | $123 |
| Group psychotherapy CPT 90853 • Mental Health | $42 | $49 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $216 | $256 | $296 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $196 | $276 | $386 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $274 | $297 | $320 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $252 | $465 | $678 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $794 | $807 | $820 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $124 | $153 | $209 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $175 | $228 | $334 |
| EMG needle each extremity complete CPT 95886 • Neurology | $80 | $132 | $184 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $80 | $125 | $170 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $46 | $128 | $212 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $121 | $132 | $143 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $280 | $307 | $334 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $460 | $502 | $544 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $64 | $70 | $77 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $111 | $121 | $130 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $151 | $191 | $267 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $58 | $164 | $234 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $34 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $42 | $51 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $71 | $75 | $79 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $115 | $151 | $221 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $159 | $228 | $298 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $92 | $134 | $175 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $153 | $164 | $175 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $149 | $199 | $230 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $46 | $69 | $92 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $92 | $121 | $150 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $75 | $93 | $111 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $92 | $94 | $96 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $91 | $103 | $113 |
| Consultation office straightforward CPT 99241 • Office Visits | $54 | $54 | $54 |
| Consultation office low complexity CPT 99243 • Office Visits | $102 | $137 | $165 |
| Consultation office high complexity CPT 99245 • Office Visits | $270 | $280 | $301 |