| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $31 | $120 | $211 |
| Interactive complexity add-on CPT 90785 • Mental Health | $18 | $29 | $39 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $137 | $198 | $364 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $202 | $286 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $70 | $111 | $178 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $64 | $114 | $184 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $122 | $162 | $221 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $160 | $239 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $103 | $252 | $401 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $149 | $149 | $149 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $213 | $213 | $213 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $110 | $110 | $110 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $89 | $188 | $287 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $124 | $139 | $155 |
| Group psychotherapy CPT 90853 • Mental Health | $56 | $68 | $80 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $8 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $85 | $204 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $183 | $262 | $341 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $170 | $183 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $76 | $382 | $992 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $153 | $201 | $250 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $46 | $46 | $46 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $56 | $56 | $56 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $122 | $138 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $66 | $66 | $66 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $67 | $90 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $136 | $271 | $406 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $146 | $193 | $257 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $361 | $418 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $49 | $78 | $100 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $89 | $125 | $156 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $96 | $196 | $263 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $141 | $241 | $346 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $20 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $51 | $69 | $79 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $78 | $102 | $143 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $90 | $156 | $202 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $135 | $165 | $187 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $100 | $175 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $169 | $202 | $268 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $211 | $291 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $51 | $63 | $77 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $92 | $112 | $142 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $131 | $164 | $217 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $93 | $114 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $128 | $178 |
| Consultation office straightforward CPT 99241 • Office Visits | $63 | $63 | $63 |
| Consultation office low complexity CPT 99243 • Office Visits | $123 | $154 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $301 | $309 | $313 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,770 | $1,770 | $1,770 |