| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $51 | $130 | $258 |
| Interactive complexity add-on CPT 90785 • Mental Health | $10 | $18 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $240 | $339 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $166 | $272 | $363 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $65 | $126 | $162 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $92 | $112 | $166 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $160 | $216 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $65 | $143 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $109 | $192 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $151 | $229 | $278 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $318 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $55 | $122 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $83 | $167 | $261 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $225 | $271 |
| Group psychotherapy CPT 90853 • Mental Health | $15 | $36 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $237 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $135 | $281 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $136 | $264 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $382 | $706 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $441 | $826 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $125 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $149 | $169 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $64 | $87 | $107 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $91 | $99 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $94 | $147 | $287 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $53 | $103 | $145 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $229 | $267 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $264 | $476 | $753 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $104 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $132 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $157 | $234 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $165 | $246 | $334 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $23 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $66 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $69 | $82 | $101 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $102 | $127 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $137 | $185 | $219 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $138 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $118 | $210 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $157 | $248 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $59 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $104 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $108 | $151 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $73 | $105 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $104 | $141 | $211 |
| Consultation office straightforward CPT 99241 • Office Visits | $71 | $71 | $71 |
| Consultation office low complexity CPT 99243 • Office Visits | $72 | $140 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $204 | $270 | $445 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $545 | $1,031 | $1,518 |