| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $48 | $103 | $145 |
| Interactive complexity add-on CPT 90785 • Mental Health | $34 | $34 | $34 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $173 | $195 | $211 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $265 | $313 | $448 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $84 | $109 | $150 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $98 | $100 | $102 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $113 | $128 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $98 | $107 | $125 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $139 | $225 | $332 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $150 | $150 | $150 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $199 | $199 | $199 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $96 | $96 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $128 | $139 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $125 | $164 | $226 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $49 | $61 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $8 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $125 | $192 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $295 | $295 | $295 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $164 | $181 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $90 | $364 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $569 | $583 | $596 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $255 | $255 | $255 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $114 | $114 | $114 |
| EMG needle each extremity complete CPT 95886 • Neurology | $67 | $112 | $141 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $118 | $118 | $118 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $70 | $70 | $70 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $124 | $201 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $180 | $236 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $232 | $316 | $382 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $86 | $109 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $96 | $130 | $149 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $175 | $204 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $216 | $298 | $400 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $27 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $48 | $76 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $90 | $140 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $125 | $153 | $172 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $196 | $239 | $276 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $97 | $131 | $171 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $171 | $186 | $199 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $168 | $235 | $276 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $62 | $85 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $99 | $113 | $130 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $110 | $142 | $181 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $99 | $115 | $130 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $139 | $153 |
| Consultation office straightforward CPT 99241 • Office Visits | $29 | $29 | $29 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $97 | $167 |
| Consultation office high complexity CPT 99245 • Office Visits | $222 | $222 | $222 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,608 | $1,608 | $1,608 |