| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $52 | $125 | $258 |
| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $16 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $124 | $189 | $337 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $124 | $244 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $65 | $109 | $162 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $70 | $107 | $167 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $68 | $112 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $78 | $135 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $207 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $106 | $197 | $277 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $318 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $95 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $143 | $261 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $78 | $179 | $271 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $51 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $165 | $259 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $115 | $259 | $393 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $117 | $262 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $405 | $851 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $526 | $971 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $97 | $196 | $296 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $138 | $160 | $203 |
| EMG needle each extremity complete CPT 95886 • Neurology | $64 | $86 | $107 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $77 | $155 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $100 | $144 | $167 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $112 | $125 | $145 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $157 | $228 | $267 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $237 | $375 | $476 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $104 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $168 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $138 | $196 | $258 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $173 | $241 | $334 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $30 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $39 | $60 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $66 | $89 | $101 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $90 | $128 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $150 | $203 | $281 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $137 | $163 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $210 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $146 | $256 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $87 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $64 | $105 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $95 | $142 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $64 | $108 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $152 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $50 | $50 | $50 |
| Consultation office low complexity CPT 99243 • Office Visits | $124 | $178 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $185 | $292 | $382 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,678 | $1,678 | $1,678 |