| Obstetric ultrasound limited CPT 76815 • Maternity | $30 | $30 | $30 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $76 | $76 | $76 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $12 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $143 | $167 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $159 | $178 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $61 | $81 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $86 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $103 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $99 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $140 | $148 | $157 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $111 | $138 | $158 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $101 | $134 | $167 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $73 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $84 | $115 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $127 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $53 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $184 | $184 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $36 | $42 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $143 | $152 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $73 | $198 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $370 | $370 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $107 | $107 | $107 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $116 | $151 |
| EMG needle each extremity complete CPT 95886 • Neurology | $79 | $79 | $79 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $50 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $21 | $62 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $105 | $136 | $168 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $259 | $272 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $74 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $111 | $130 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $69 | $135 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $11 | $77 | $178 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $16 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $55 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $69 | $90 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $61 | $122 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $160 | $174 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $82 | $148 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $124 | $144 | $164 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $19 | $127 | $239 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $81 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $70 | $115 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $15 | $78 | $123 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $74 | $115 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $105 | $126 |
| Consultation office low complexity CPT 99243 • Office Visits | $42 | $84 | $117 |
| Consultation office high complexity CPT 99245 • Office Visits | $165 | $202 | $269 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $512 | $512 | $512 |