| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $39 | $48 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $56 | $69 | $82 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $13 | $21 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $191 | $194 | $197 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $191 | $202 | $212 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $93 | $94 | $94 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $97 | $100 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $127 | $128 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $116 | $119 | $123 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $190 | $190 | $190 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $136 | $163 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $198 | $198 | $198 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $88 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $151 | $152 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $154 | $158 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $38 | $38 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $252 | $252 | $252 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $112 | $194 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $152 | $170 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $432 | $497 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $483 | $483 | $483 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $142 | $173 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $122 | $141 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $58 | $74 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $140 | $168 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $85 | $109 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $156 | $166 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $278 | $282 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $92 | $105 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $110 | $117 | $125 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $150 | $183 | $235 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $182 | $273 | $343 |
| Office visit established patient minimal CPT 99211 • Office Visits | $13 | $29 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $36 | $70 | $86 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $103 | $128 | $141 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $101 | $151 | $200 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $205 | $243 | $280 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $146 | $175 | $190 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $198 | $204 | $210 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $193 | $265 | $309 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $44 | $50 | $57 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $62 | $104 | $145 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $150 | $156 | $160 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $65 | $104 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $125 | $154 |
| Consultation office straightforward CPT 99241 • Office Visits | $48 | $48 | $48 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $111 | $178 |
| Consultation office high complexity CPT 99245 • Office Visits | $172 | $235 | $279 |