| Obstetric ultrasound limited CPT 76815 • Maternity | $50 | $81 | $113 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $51 | $97 | $143 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $15 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $198 | $275 | $339 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $214 | $257 | $283 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $65 | $114 | $141 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $92 | $101 | $118 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $96 | $152 | $183 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $149 | $150 | $153 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $142 | $210 | $261 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $165 | $212 | $248 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $236 | $267 | $298 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $113 | $134 | $147 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $179 | $217 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $205 | $264 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $47 | $71 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $8 | $9 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $190 | $309 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $258 | $265 | $271 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $224 | $244 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $344 | $609 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $390 | $699 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $118 | $118 | $118 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $148 | $148 | $148 |
| EMG needle each extremity complete CPT 95886 • Neurology | $64 | $110 | $157 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $169 | $169 | $169 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $94 | $95 | $96 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $144 | $170 | $197 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $192 | $226 | $259 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $336 | $374 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $102 | $127 | $152 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $145 | $183 | $221 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $219 | $244 | $270 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $360 | $392 | $425 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $25 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $60 | $74 | $88 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $99 | $124 | $149 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $188 | $204 | $220 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $150 | $191 | $231 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $139 | $176 | $212 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $158 | $221 | $285 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $347 | $385 | $422 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $46 | $64 | $82 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $99 | $125 | $150 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $179 | $198 | $217 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $100 | $125 | $150 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $147 | $185 | $223 |
| Consultation office straightforward CPT 99241 • Office Visits | $71 | $71 | $71 |
| Consultation office low complexity CPT 99243 • Office Visits | $215 | $233 | $251 |
| Consultation office high complexity CPT 99245 • Office Visits | $260 | $360 | $460 |