| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $84 | $128 | $154 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $146 | $214 | $281 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $122 | $240 | $324 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $48 | $48 | $48 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $40 | $81 | $122 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $79 | $113 | $147 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $110 | $143 | $176 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $107 | $107 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $159 | $159 | $159 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $83 | $83 | $83 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $74 | $74 | $74 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $93 | $93 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $26 | $26 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $61 | $61 | $61 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $104 | $161 | $218 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $110 | $110 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $132 | $405 | $678 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $180 | $485 | $790 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $42 | $42 | $42 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $31 | $31 | $31 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $106 | $166 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $50 | $50 | $50 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $48 | $48 | $48 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $76 | $156 | $236 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $74 | $74 | $74 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $180 | $340 | $501 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $53 | $89 | $125 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $57 | $119 | $181 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $119 | $231 | $296 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $150 | $250 | $372 |
| Office visit established patient minimal CPT 99211 • Office Visits | $7 | $7 | $7 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $19 | $38 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $37 | $81 | $126 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $57 | $160 | $214 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $82 | $147 | $212 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $94 | $113 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $102 | $157 | $211 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $150 | $227 | $282 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $31 | $55 | $80 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $55 | $87 | $119 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $79 | $136 | $192 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $56 | $91 | $126 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $145 | $186 |
| Consultation office straightforward CPT 99241 • Office Visits | $27 | $27 | $27 |
| Consultation office low complexity CPT 99243 • Office Visits | $105 | $105 | $105 |
| Consultation office high complexity CPT 99245 • Office Visits | $190 | $190 | $190 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $497 | $497 | $497 |