| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $64 | $110 | $164 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $8 | $12 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $117 | $162 | $184 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $127 | $155 | $168 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $72 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $88 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $75 | $105 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $74 | $96 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $114 | $149 | $185 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $98 | $129 | $145 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $119 | $135 | $152 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $56 | $56 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $92 | $119 | $154 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $95 | $158 | $189 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $38 | $53 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $87 | $177 | $266 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $142 | $208 | $270 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $123 | $127 | $130 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $51 | $239 | $333 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $311 | $331 | $350 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $59 | $94 | $112 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $76 | $76 | $76 |
| EMG needle each extremity complete CPT 95886 • Neurology | $58 | $68 | $79 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $84 | $87 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $60 | $95 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $57 | $108 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $104 | $171 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $91 | $220 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $69 | $94 | $107 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $101 | $130 | $158 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $154 | $213 | $242 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $161 | $256 | $304 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $29 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $55 | $63 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $68 | $91 | $103 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $100 | $138 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $135 | $173 | $212 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $97 | $132 | $149 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $130 | $169 | $209 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $193 | $268 | $305 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $50 | $62 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $69 | $98 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $99 | $140 | $160 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $69 | $99 | $115 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $144 | $166 |
| Consultation office straightforward CPT 99241 • Office Visits | $57 | $57 | $57 |
| Consultation office low complexity CPT 99243 • Office Visits | $115 | $153 | $211 |
| Consultation office high complexity CPT 99245 • Office Visits | $181 | $189 | $195 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $589 | $589 | $589 |