| Obstetric ultrasound limited CPT 76815 • Maternity | $32 | $32 | $32 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $67 | $93 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $11 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $130 | $159 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $144 | $168 | $189 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $63 | $70 | $76 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $74 | $87 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $84 | $114 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $83 | $93 | $98 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $125 | $149 | $185 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $123 | $145 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $122 | $132 | $143 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $64 | $70 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $102 | $115 | $134 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $101 | $119 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $47 | $59 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $3 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $12 | $97 | $154 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $66 | $90 | $114 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $15 | $81 | $123 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $57 | $201 | $362 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $269 | $417 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $66 | $94 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $81 | $104 | $150 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $78 | $98 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $39 | $62 | $85 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $48 | $73 | $105 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $35 | $102 | $165 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $101 | $220 | $288 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $55 | $64 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $41 | $77 | $104 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $13 | $57 | $127 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $27 | $114 | $200 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $18 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $42 | $43 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $50 | $62 | $70 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $12 | $72 | $104 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $119 | $133 | $140 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $55 | $73 | $99 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $101 | $116 | $134 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $29 | $120 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $62 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $46 | $59 | $71 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $10 | $68 | $102 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $62 | $83 | $116 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $88 | $94 | $105 |
| Consultation office straightforward CPT 99241 • Office Visits | $32 | $32 | $32 |
| Consultation office low complexity CPT 99243 • Office Visits | $94 | $127 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $180 | $204 | $218 |