| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $46 | $147 | $264 |
| Interactive complexity add-on CPT 90785 • Mental Health | $51 | $51 | $51 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $137 | $298 | $595 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $181 | $343 | $666 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $258 | $258 | $258 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $212 | $212 | $212 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $211 | $341 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $299 | $299 | $299 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $121 | $283 | $444 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $356 | $356 | $356 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $481 | $481 | $481 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $213 | $213 | $213 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $125 | $226 | $327 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $340 | $340 | $340 |
| Group psychotherapy CPT 90853 • Mental Health | $91 | $91 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $10 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $215 | $328 | $441 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $453 | $453 | $453 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $305 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $189 | $228 | $267 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $440 | $855 | $1,270 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $374 | $374 | $374 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $271 | $271 | $271 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $212 | $325 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $176 | $176 | $176 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $67 | $118 | $220 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $136 | $200 | $264 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $178 | $206 | $235 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $457 | $622 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $87 | $98 | $110 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $128 | $158 | $189 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $138 | $256 | $327 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $113 | $319 | $432 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $33 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $51 | $82 | $114 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $84 | $109 | $134 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $140 | $258 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $172 | $267 | $362 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $122 | $156 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $171 | $234 | $297 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $250 | $299 | $397 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $51 | $82 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $92 | $136 | $181 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $131 | $202 | $272 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $93 | $139 | $184 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $159 | $261 |
| Consultation office straightforward CPT 99241 • Office Visits | $76 | $76 | $76 |
| Consultation office low complexity CPT 99243 • Office Visits | $171 | $238 | $341 |
| Consultation office high complexity CPT 99245 • Office Visits | $484 | $554 | $624 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,835 | $1,835 | $1,835 |