| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $57 | $79 | $102 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $15 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $163 | $220 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $109 | $225 | $311 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $83 | $111 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $37 | $76 | $114 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $67 | $107 | $147 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $61 | $102 | $144 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $107 | $163 | $219 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $98 | $144 | $190 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $154 | $192 | $230 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $80 | $95 | $110 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $75 | $126 | $178 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $87 | $136 | $185 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $34 | $44 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $132 | $223 | $314 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $115 | $186 | $257 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $112 | $191 | $244 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $89 | $287 | $595 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $190 | $434 | $678 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $67 | $137 | $207 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $31 | $90 | $148 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $94 | $154 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $105 | $164 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $58 | $135 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $54 | $137 | $219 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $254 | $332 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $102 | $301 | $501 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $32 | $87 | $115 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $48 | $107 | $165 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $100 | $177 | $253 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $105 | $204 | $324 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $24 | $37 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $60 | $89 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $43 | $99 | $143 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $65 | $82 | $104 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $70 | $147 | $223 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $64 | $126 | $157 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $87 | $150 | $213 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $129 | $234 | $315 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $26 | $44 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $48 | $90 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $68 | $130 | $162 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $47 | $91 | $113 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $69 | $118 | $166 |
| Consultation office straightforward CPT 99241 • Office Visits | $77 | $77 | $77 |
| Consultation office low complexity CPT 99243 • Office Visits | $88 | $139 | $191 |
| Consultation office high complexity CPT 99245 • Office Visits | $160 | $254 | $348 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $446 | $762 | $1,078 |