| Obstetric ultrasound limited CPT 76815 • Maternity | $41 | $68 | $95 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $77 | $93 | $109 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $22 | $28 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $115 | $164 | $247 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $170 | $206 | $276 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $75 | $100 | $124 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $77 | $102 | $127 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $100 | $132 | $163 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $88 | $124 | $160 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $127 | $187 | $247 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $128 | $170 | $213 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $156 | $206 | $256 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $74 | $99 | $123 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $79 | $139 | $199 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $109 | $158 | $207 |
| Group psychotherapy CPT 90853 • Mental Health | $41 | $45 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $116 | $209 | $303 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $124 | $174 | $224 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $181 | $236 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $352 | $453 | $555 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $412 | $530 | $648 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $106 | $114 | $131 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $154 | $156 | $159 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $133 | $172 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $85 | $134 | $184 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $105 | $106 | $107 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $128 | $142 | $156 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $163 | $165 | $168 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $272 | $318 | $364 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $86 | $86 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $108 | $145 | $183 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $107 | $193 | $279 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $166 | $289 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $16 | $16 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $45 | $59 | $73 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $75 | $81 | $87 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $110 | $134 | $182 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $148 | $197 | $246 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $174 | $174 | $174 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $235 | $235 | $235 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $16 | $182 | $348 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $67 | $67 | $67 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $124 | $124 | $124 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $179 | $179 | $179 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $125 | $125 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $134 | $184 |
| Consultation office straightforward CPT 99241 • Office Visits | $82 | $82 | $82 |
| Consultation office low complexity CPT 99243 • Office Visits | $131 | $149 | $168 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $194 | $331 |