| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $56 | $113 | $154 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $6 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $134 | $237 | $361 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $138 | $255 | $405 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $71 | $112 | $164 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $47 | $95 | $164 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $92 | $143 | $217 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $92 | $108 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $135 | $170 | $198 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $148 | $173 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $266 | $266 | $266 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $138 | $138 | $138 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $89 | $152 | $240 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $171 | $240 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $39 | $48 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $184 | $200 | $217 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $146 | $198 | $231 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $146 | $159 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $193 | $382 | $678 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $180 | $388 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $74 | $80 | $86 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $113 | $115 | $118 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $94 | $166 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $97 | $149 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $73 | $129 | $184 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $67 | $174 | $236 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $117 | $141 | $165 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $126 | $270 | $501 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $85 | $106 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $82 | $106 | $181 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $134 | $192 | $296 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $214 | $451 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $31 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $21 | $63 | $115 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $57 | $75 | $119 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $86 | $140 | $263 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $117 | $176 | $234 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $154 | $273 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $115 | $152 | $179 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $169 | $244 | $282 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $35 | $51 | $68 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $62 | $123 | $207 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $89 | $164 | $243 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $95 | $131 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $92 | $145 | $186 |
| Consultation office straightforward CPT 99241 • Office Visits | $45 | $45 | $45 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $124 | $132 |
| Consultation office high complexity CPT 99245 • Office Visits | $178 | $219 | $260 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $641 | $756 | $871 |