| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $29 | $109 | $247 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $26 | $36 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $131 | $257 | $339 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $166 | $294 | $375 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $79 | $141 | $180 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $99 | $150 | $180 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $85 | $160 | $218 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $111 | $164 | $216 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $142 | $247 | $329 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $147 | $215 | $283 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $318 | $329 | $341 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $163 | $163 | $163 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $137 | $212 | $264 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $206 | $273 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $73 | $124 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $10 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $127 | $209 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $247 | $296 | $346 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $202 | $271 | $340 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $561 | $906 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $73 | $340 | $798 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $134 | $134 | $134 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $216 | $216 | $216 |
| EMG needle each extremity complete CPT 95886 • Neurology | $116 | $178 | $231 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $125 | $204 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $94 | $181 | $252 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $102 | $257 | $366 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $136 | $341 | $488 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $412 | $450 | $488 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $94 | $108 | $131 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $102 | $174 | $277 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $102 | $191 | $338 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $102 | $255 | $532 |
| Office visit established patient minimal CPT 99211 • Office Visits | $24 | $52 | $102 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $74 | $102 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $88 | $125 | $186 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $102 | $153 | $274 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $102 | $207 | $370 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $126 | $198 | $264 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $102 | $209 | $355 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $102 | $252 | $525 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $49 | $85 | $102 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $77 | $137 | $186 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $119 | $201 | $269 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $98 | $129 | $186 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $133 | $217 | $276 |
| Consultation office straightforward CPT 99241 • Office Visits | $56 | $56 | $56 |
| Consultation office low complexity CPT 99243 • Office Visits | $102 | $225 | $318 |
| Consultation office high complexity CPT 99245 • Office Visits | $102 | $261 | $573 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,552 | $1,552 | $1,552 |