| Obstetric ultrasound limited CPT 76815 • Maternity | $27 | $47 | $85 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $32 | $70 | $94 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $160 | $171 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $132 | $171 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $67 | $84 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $44 | $83 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $86 | $115 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $72 | $101 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $126 | $132 | $138 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $116 | $128 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $177 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $86 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $94 | $119 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $113 | $138 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $34 | $50 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $191 | $191 | $191 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $106 | $183 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $130 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $167 | $267 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $201 | $201 | $201 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $95 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $117 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $93 | $93 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $69 | $101 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $73 | $124 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $141 | $149 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $186 | $196 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $303 | $322 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $49 | $63 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $74 | $91 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $135 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $133 | $188 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $25 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $47 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $53 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $63 | $94 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $93 | $134 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $84 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $87 | $128 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $121 | $162 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $26 | $78 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $67 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $73 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $71 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $73 | $101 | $130 |
| Consultation office straightforward CPT 99241 • Office Visits | $38 | $38 | $38 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $61 | $93 |
| Consultation office high complexity CPT 99245 • Office Visits | $170 | $193 | $217 |