| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $55 | $127 | $190 |
| Interactive complexity add-on CPT 90785 • Mental Health | $28 | $29 | $30 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $77 | $192 | $267 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $86 | $209 | $331 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $45 | $105 | $155 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $44 | $44 | $44 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $57 | $131 | $206 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $50 | $50 | $50 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $85 | $155 | $225 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $73 | $73 | $73 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $80 | $80 | $80 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $50 | $50 | $50 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $73 | $73 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $75 | $75 | $75 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $20 | $20 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $147 | $147 | $147 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $85 | $85 | $85 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $79 | $79 | $79 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $260 | $312 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $42 | $177 | $374 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $125 | $125 | $125 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $123 | $123 | $123 |
| EMG needle each extremity complete CPT 95886 • Neurology | $60 | $104 | $149 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $30 | $30 | $30 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $47 | $82 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $50 | $50 | $50 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $156 | $156 | $156 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $204 | $204 | $204 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $54 | $81 | $119 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $42 | $108 | $216 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $150 | $224 | $333 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $127 | $238 | $427 |
| Office visit established patient minimal CPT 99211 • Office Visits | $13 | $24 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $28 | $60 | $111 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $42 | $90 | $176 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $42 | $94 | $218 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $68 | $229 | $353 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $171 | $187 | $197 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $98 | $179 | $269 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $254 | $385 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $63 | $83 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $44 | $91 | $117 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $100 | $169 | $204 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $91 | $138 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $76 | $149 | $210 |
| Consultation office straightforward CPT 99241 • Office Visits | $20 | $20 | $20 |
| Consultation office low complexity CPT 99243 • Office Visits | $187 | $187 | $187 |
| Consultation office high complexity CPT 99245 • Office Visits | $138 | $138 | $138 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,017 | $1,017 | $1,017 |