| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $101 | $137 | $172 |
| Interactive complexity add-on CPT 90785 • Mental Health | $46 | $46 | $46 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $536 | $536 | $536 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $600 | $600 | $600 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $232 | $232 | $232 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $212 | $212 | $212 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $307 | $307 | $307 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $269 | $269 | $269 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $452 | $452 | $452 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $356 | $356 | $356 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $433 | $433 | $433 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $214 | $214 | $214 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $295 | $295 | $295 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $308 | $308 | $308 |
| Group psychotherapy CPT 90853 • Mental Health | $82 | $82 | $82 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $14 | $14 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $216 | $289 | $362 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $372 | $372 | $372 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $371 | $371 | $371 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $607 | $871 | $1,134 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $651 | $898 | $1,144 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $184 | $184 | $184 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $238 | $305 | $338 |
| EMG needle each extremity complete CPT 95886 • Neurology | $137 | $193 | $249 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $111 | $190 | $270 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $336 | $336 | $336 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $165 | $169 | $173 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $212 | $368 | $525 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $863 | $863 | $863 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $141 | $150 | $158 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $149 | $197 | $245 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $298 | $358 | $412 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $432 | $478 | $521 |
| Office visit established patient minimal CPT 99211 • Office Visits | $44 | $45 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $109 | $110 | $112 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $177 | $178 | $179 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $254 | $263 | $267 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $352 | $355 | $357 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $183 | $234 | $285 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $287 | $336 | $384 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $383 | $493 | $566 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $109 | $109 | $109 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $175 | $189 | $203 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $263 | $277 | $292 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $178 | $191 | $203 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $252 | $278 | $300 |
| Consultation office straightforward CPT 99241 • Office Visits | $77 | $77 | $77 |
| Consultation office low complexity CPT 99243 • Office Visits | $250 | $318 | $363 |
| Consultation office high complexity CPT 99245 • Office Visits | $467 | $584 | $660 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,738 | $1,738 | $1,738 |