| Obstetric ultrasound limited CPT 76815 • Maternity | $21 | $50 | $79 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $12 | $51 | $90 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $8 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $105 | $121 | $139 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $124 | $134 | $155 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $60 | $66 | $70 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $64 | $69 | $72 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $68 | $76 | $91 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $75 | $81 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $106 | $120 | $139 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $90 | $101 | $107 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $106 | $128 | $155 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $52 | $63 | $69 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $96 | $110 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $102 | $116 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $41 | $48 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $135 | $136 | $137 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $52 | $90 | $127 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $83 | $106 | $118 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $253 | $292 | $336 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $57 | $152 | $328 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $48 | $67 | $96 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $138 | $157 | $186 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $68 | $92 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $59 | $73 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $49 | $69 | $99 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $26 | $58 | $79 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $91 | $113 | $156 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $47 | $156 | $236 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $6 | $44 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $107 | $111 | $116 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $117 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $45 | $105 | $183 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $17 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $40 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $4 | $40 | $65 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $86 | $97 | $114 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $140 | $149 | $157 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $9 | $86 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $11 | $102 | $149 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $182 | $196 | $220 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $3 | $37 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $65 | $68 | $73 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $44 | $84 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $65 | $70 | $79 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $101 | $108 |
| Consultation office straightforward CPT 99241 • Office Visits | $35 | $35 | $35 |
| Consultation office low complexity CPT 99243 • Office Visits | $36 | $80 | $105 |
| Consultation office high complexity CPT 99245 • Office Visits | $40 | $144 | $208 |