| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $47 | $47 | $47 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $121 | $149 | $176 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $119 | $119 | $119 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $53 | $53 | $53 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $61 | $61 | $61 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $79 | $79 | $79 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $70 | $70 | $70 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $111 | $114 | $118 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $101 | $101 | $101 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $123 | $123 | $123 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $59 | $59 | $59 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $87 | $87 | $87 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $89 | $95 | $100 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $23 | $23 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $115 | $115 | $115 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $97 | $97 | $97 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $110 | $110 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $247 | $247 | $247 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $351 | $351 | $351 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $99 | $99 | $99 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $142 | $142 | $142 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $41 | $41 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $46 | $46 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $57 | $57 | $57 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $67 | $67 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $91 | $91 | $91 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $42 | $82 | $102 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $63 | $108 | $152 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $136 | $149 | $171 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $172 | $196 | $228 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $19 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $37 | $53 | $60 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $43 | $70 | $83 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $90 | $103 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $121 | $155 | $190 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $85 | $142 | $171 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $115 | $115 | $115 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $170 | $170 | $170 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $33 | $33 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $87 | $87 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $61 | $61 | $61 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $90 | $90 |
| Consultation office straightforward CPT 99241 • Office Visits | $104 | $104 | $104 |
| Consultation office low complexity CPT 99243 • Office Visits | $81 | $81 | $81 |
| Consultation office high complexity CPT 99245 • Office Visits | $188 | $188 | $188 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $509 | $555 | $601 |