| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $38 | $45 | $60 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $6 | $7 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $162 | $188 | $229 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $135 | $198 | $229 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $97 | $123 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $88 | $88 | $88 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $73 | $104 | $120 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $121 | $121 | $121 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $118 | $146 | $174 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $177 | $177 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $92 | $92 | $92 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $93 | $93 | $93 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $114 | $114 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $31 | $31 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $149 | $149 | $149 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $164 | $164 | $164 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $121 | $121 | $121 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $58 | $58 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $149 | $149 | $149 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $88 | $88 | $88 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $84 | $84 | $84 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $41 | $41 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $99 | $99 | $99 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $123 | $123 | $123 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $63 | $63 | $63 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $112 | $112 | $112 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $120 | $120 | $120 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $71 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $36 | $90 | $142 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $131 | $184 | $215 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $167 | $215 | $259 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $26 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $23 | $43 | $78 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $36 | $62 | $127 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $36 | $100 | $179 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $36 | $128 | $234 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $66 | $124 | $205 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $109 | $161 | $205 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $36 | $161 | $231 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $47 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $36 | $85 | $156 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $77 | $130 | $156 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $36 | $88 | $156 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $129 | $156 |
| Consultation office straightforward CPT 99241 • Office Visits | $29 | $29 | $29 |
| Consultation office low complexity CPT 99243 • Office Visits | $90 | $125 | $174 |
| Consultation office high complexity CPT 99245 • Office Visits | $178 | $178 | $178 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $553 | $553 | $553 |