| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $91 | $115 | $160 |
| Interactive complexity add-on CPT 90785 • Mental Health | $20 | $35 | $51 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $176 | $333 | $595 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $195 | $350 | $587 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $86 | $172 | $258 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $95 | $165 | $236 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $121 | $231 | $341 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $144 | $206 | $268 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $219 | $360 | $501 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $190 | $293 | $395 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $230 | $356 | $481 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $110 | $162 | $213 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $178 | $253 | $327 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $185 | $263 | $340 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $68 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $11 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $124 | $166 | $209 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $281 | $453 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $232 | $357 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $410 | $834 | $1,258 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $481 | $970 | $1,459 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $207 | $290 | $374 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $142 | $207 | $271 |
| EMG needle each extremity complete CPT 95886 • Neurology | $138 | $155 | $173 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $126 | $151 | $176 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $156 | $229 | $373 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $183 | $217 | $250 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $235 | $240 | $245 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $501 | $729 | $958 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $88 | $126 | $164 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $124 | $189 | $254 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $191 | $298 | $378 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $198 | $376 | $499 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $26 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $52 | $72 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $86 | $134 | $182 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $126 | $170 | $258 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $144 | $217 | $291 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $149 | $169 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $34 | $166 | $297 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $34 | $223 | $397 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $100 | $107 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $100 | $140 | $181 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $34 | $153 | $272 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $100 | $142 | $184 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $125 | $171 | $261 |
| Consultation office straightforward CPT 99241 • Office Visits | $77 | $77 | $77 |
| Consultation office low complexity CPT 99243 • Office Visits | $149 | $231 | $341 |
| Consultation office high complexity CPT 99245 • Office Visits | $294 | $357 | $484 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,835 | $1,835 | $1,835 |