| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $87 | $96 | $104 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $30 | $51 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $102 | $349 | $595 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $167 | $416 | $666 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $140 | $228 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $148 | $236 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $95 | $199 | $302 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $68 | $183 | $299 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $139 | $292 | $444 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $113 | $234 | $356 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $286 | $428 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $154 | $238 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $202 | $326 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $208 | $340 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $55 | $80 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $10 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $441 | $441 | $441 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $393 | $393 | $393 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $357 | $357 | $357 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $189 | $189 | $189 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $919 | $1,459 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $374 | $374 | $374 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $264 | $264 | $264 |
| EMG needle each extremity complete CPT 95886 • Neurology | $173 | $173 | $173 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $299 | $299 | $299 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $220 | $220 | $220 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $264 | $264 | $264 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $235 | $235 | $235 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $958 | $958 | $958 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $65 | $123 | $164 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $194 | $254 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $201 | $277 | $327 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $191 | $374 | $499 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $27 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $92 | $114 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $42 | $134 | $182 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $177 | $252 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $184 | $299 | $362 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $180 | $285 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $121 | $267 | $384 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $371 | $566 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $88 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $91 | $158 | $203 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $217 | $292 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $153 | $203 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $221 | $300 |
| Consultation office straightforward CPT 99241 • Office Visits | $27 | $27 | $27 |
| Consultation office low complexity CPT 99243 • Office Visits | $259 | $300 | $341 |
| Consultation office high complexity CPT 99245 • Office Visits | $484 | $554 | $624 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $758 | $1,415 | $2,071 |