| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $118 | $229 |
| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $188 | $255 | $329 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $319 | $354 | $371 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $86 | $123 | $160 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $79 | $123 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $160 | $181 | $202 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $186 | $186 | $186 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $166 | $166 | $166 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $132 | $132 | $132 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $295 | $295 | $295 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $151 | $151 | $151 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $228 | $228 | $228 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $111 | $111 | $111 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $41 | $56 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $9 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $363 | $385 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $165 | $165 | $165 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $321 | $321 | $321 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $130 | $449 | $768 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $790 | $833 | $877 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $72 | $72 | $72 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $87 | $87 | $87 |
| EMG needle each extremity complete CPT 95886 • Neurology | $48 | $48 | $48 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $44 | $44 | $44 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $54 | $54 | $54 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $185 | $185 | $185 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $242 | $242 | $242 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $84 | $125 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $125 | $190 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $146 | $308 | $398 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $174 | $318 | $500 |
| Office visit established patient minimal CPT 99211 • Office Visits | $37 | $45 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $85 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $85 | $146 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $143 | $223 | $263 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $185 | $298 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $168 | $198 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $143 | $225 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $336 | $425 | $487 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $71 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $86 | $124 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $173 | $203 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $121 | $142 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $125 | $207 | $258 |
| Consultation office straightforward CPT 99241 • Office Visits | $63 | $63 | $63 |
| Consultation office low complexity CPT 99243 • Office Visits | $202 | $238 | $273 |
| Consultation office high complexity CPT 99245 • Office Visits | $197 | $348 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,317 | $1,411 | $1,504 |