| Obstetric ultrasound limited CPT 76815 • Maternity | $22 | $28 | $34 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $25 | $42 | $62 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $6 | $10 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $114 | $120 | $129 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $106 | $120 | $130 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $58 | $70 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $48 | $63 | $70 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $68 | $72 | $78 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $61 | $74 | $91 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $79 | $97 | $111 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $81 | $97 | $106 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $98 | $109 | $124 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $49 | $54 | $62 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $65 | $75 | $92 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $68 | $79 | $91 |
| Group psychotherapy CPT 90853 • Mental Health | $19 | $38 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $7 | $80 | $135 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $16 | $51 | $93 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $93 | $105 | $117 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $264 | $278 | $286 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $37 | $176 | $328 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $33 | $62 | $96 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $54 | $88 | $138 |
| EMG needle each extremity complete CPT 95886 • Neurology | $14 | $50 | $72 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $16 | $42 | $77 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $43 | $81 | $100 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $24 | $59 | $90 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $31 | $79 | $156 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $122 | $169 | $236 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $6 | $37 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $55 | $75 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $45 | $98 | $137 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $148 | $154 | $160 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $16 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $38 | $45 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $49 | $61 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $57 | $78 | $90 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $85 | $121 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $55 | $96 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $58 | $97 | $146 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $26 | $108 | $185 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $5 | $34 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $49 | $65 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $44 | $72 | $94 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $54 | $61 | $66 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $76 | $88 | $97 |
| Consultation office straightforward CPT 99241 • Office Visits | $52 | $52 | $52 |
| Consultation office low complexity CPT 99243 • Office Visits | $45 | $82 | $124 |
| Consultation office high complexity CPT 99245 • Office Visits | $25 | $117 | $185 |