| Obstetric ultrasound limited CPT 76815 • Maternity | $67 | $106 | $140 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $42 | $76 | $112 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $17 | $20 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $120 | $196 | $364 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $167 | $195 | $260 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $72 | $80 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $77 | $83 | $87 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $96 | $152 | $253 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $73 | $104 | $135 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $121 | $143 | $178 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $161 | $196 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $153 | $169 | $186 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $63 | $65 | $66 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $79 | $96 | $106 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $120 | $140 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $35 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $129 | $229 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $205 | $270 | $359 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $182 | $214 | $277 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $302 | $521 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $248 | $341 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $93 | $112 | $150 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $135 | $170 | $238 |
| EMG needle each extremity complete CPT 95886 • Neurology | $70 | $96 | $129 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $57 | $77 | $97 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $88 | $123 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $112 | $141 | $174 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $146 | $198 | $259 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $312 | $347 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $68 | $85 | $100 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $128 | $163 | $219 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $133 | $219 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $239 | $352 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $20 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $60 | $95 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $84 | $101 | $120 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $98 | $188 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $143 | $171 | $198 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $128 | $159 | $211 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $171 | $199 | $236 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $178 | $273 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $51 | $62 | $69 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $70 | $86 | $97 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $131 | $137 | $140 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $93 | $124 | $151 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $137 | $204 |
| Consultation office straightforward CPT 99241 • Office Visits | $35 | $35 | $35 |
| Consultation office low complexity CPT 99243 • Office Visits | $104 | $160 | $213 |
| Consultation office high complexity CPT 99245 • Office Visits | $276 | $289 | $303 |