| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $38 | $121 | $149 |
| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $15 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $137 | $137 | $137 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $153 | $275 | $315 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $62 | $100 | $122 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $69 | $99 | $111 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $89 | $110 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $82 | $82 | $82 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $177 | $239 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $116 | $153 | $187 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $131 | $131 | $131 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $67 | $67 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $108 | $108 | $108 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $112 | $112 | $112 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $25 | $25 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $143 | $143 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $115 | $166 | $210 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $127 | $130 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $58 | $58 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $58 | $58 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $66 | $66 | $66 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $85 | $85 | $85 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $121 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $53 | $53 | $53 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $67 | $157 | $187 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $144 | $144 | $144 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $189 | $189 | $189 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $189 | $189 | $189 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $90 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $93 | $97 | $105 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $181 | $261 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $120 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $28 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $69 | $87 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $67 | $72 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $154 | $202 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $109 | $189 | $230 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $97 | $134 | $171 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $134 | $158 | $171 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $168 | $183 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $99 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $110 | $130 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $102 | $118 | $130 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $110 | $130 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $105 | $132 | $165 |
| Consultation office straightforward CPT 99241 • Office Visits | $20 | $20 | $20 |
| Consultation office low complexity CPT 99243 • Office Visits | $93 | $138 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $219 | $312 | $343 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $595 | $840 | $962 |