| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $62 | $163 | $264 |
| Interactive complexity add-on CPT 90785 • Mental Health | $19 | $32 | $45 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $227 | $411 | $595 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $228 | $447 | $666 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $118 | $188 | $258 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $114 | $143 | $172 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $113 | $175 | $237 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $104 | $202 | $299 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $128 | $314 | $501 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $147 | $180 | $213 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $481 | $481 | $481 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $166 | $166 | $166 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $178 | $236 | $295 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $224 | $341 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $68 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $9 | $12 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $85 | $221 | $362 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $333 | $393 | $453 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $202 | $327 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $76 | $484 | $768 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $517 | $771 | $1,144 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $204 | $204 | $204 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $142 | $325 | $482 |
| EMG needle each extremity complete CPT 95886 • Neurology | $125 | $233 | $325 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $212 | $299 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $86 | $119 | $153 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $102 | $238 | $399 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $257 | $378 | $525 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $335 | $426 | $518 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $80 | $128 | $164 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $149 | $174 | $189 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $280 | $327 | $412 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $255 | $427 | $521 |
| Office visit established patient minimal CPT 99211 • Office Visits | $33 | $41 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $71 | $98 | $114 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $87 | $129 | $177 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $114 | $215 | $267 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $247 | $320 | $362 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $101 | $189 | $285 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $169 | $283 | $384 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $214 | $423 | $566 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $49 | $90 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $125 | $167 | $203 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $200 | $292 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $125 | $171 | $203 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $184 | $255 | $300 |
| Consultation office straightforward CPT 99241 • Office Visits | $56 | $56 | $56 |
| Consultation office low complexity CPT 99243 • Office Visits | $152 | $279 | $363 |
| Consultation office high complexity CPT 99245 • Office Visits | $278 | $507 | $660 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,543 | $1,689 | $1,835 |