| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $34 | $122 | $211 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $11 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $128 | $141 | $154 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $136 | $182 | $228 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $68 | $72 | $76 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $70 | $94 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $88 | $105 | $122 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $74 | $74 | $74 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $122 | $122 | $122 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $119 | $119 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $177 | $177 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $92 | $92 | $92 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $83 | $83 | $83 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $98 | $98 | $98 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $68 | $77 | $85 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $140 | $162 | $183 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $122 | $122 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $76 | $111 | $147 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $149 | $149 | $149 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $79 | $79 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $34 | $34 | $34 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $109 | $125 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $56 | $56 | $56 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $53 | $53 | $53 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $64 | $64 | $64 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $195 | $226 | $257 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $321 | $351 | $382 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $80 | $100 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $86 | $96 | $106 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $133 | $185 | $237 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $167 | $191 | $215 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $20 | $32 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $54 | $73 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $57 | $68 | $78 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $86 | $106 | $126 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $116 | $176 | $235 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $91 | $100 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $141 | $169 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $167 | $196 | $225 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $47 | $60 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $82 | $103 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $116 | $145 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $82 | $101 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $117 | $144 |
| Consultation office straightforward CPT 99241 • Office Visits | $30 | $30 | $30 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $116 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $211 | $211 | $211 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $552 | $552 | $552 |