| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $23 | $73 | $122 |
| Interactive complexity add-on CPT 90785 • Mental Health | $9 | $9 | $9 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $87 | $105 | $122 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $97 | $180 | $263 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $43 | $47 | $51 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $40 | $47 | $54 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $57 | $62 | $67 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $55 | $75 | $94 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $76 | $89 | $101 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $66 | $78 | $91 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $89 | $92 | $96 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $38 | $38 | $38 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $62 | $62 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $64 | $70 | $76 |
| Group psychotherapy CPT 90853 • Mental Health | $17 | $19 | $21 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $86 | $86 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $73 | $73 | $73 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $83 | $83 | $83 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $54 | $139 | $223 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $158 | $265 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $41 | $41 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $51 | $51 | $51 |
| EMG needle each extremity complete CPT 95886 • Neurology | $31 | $58 | $86 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $25 | $25 | $25 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $42 | $77 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $50 | $61 | $73 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $51 | $51 | $51 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $70 | $166 | $262 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $46 | $56 | $66 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $66 | $124 | $183 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $100 | $189 | $277 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $127 | $135 | $143 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $17 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $16 | $34 | $52 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $46 | $97 | $149 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $66 | $116 | $166 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $89 | $191 | $294 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $62 | $62 | $62 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $84 | $141 | $198 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $194 | $264 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $24 | $49 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $44 | $78 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $64 | $122 | $180 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $84 | $123 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $65 | $104 | $143 |
| Consultation office straightforward CPT 99241 • Office Visits | $27 | $27 | $27 |
| Consultation office low complexity CPT 99243 • Office Visits | $76 | $76 | $76 |
| Consultation office high complexity CPT 99245 • Office Visits | $138 | $138 | $138 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $337 | $337 | $337 |