| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $27 | $41 | $54 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $95 | $104 | $112 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $116 | $138 | $160 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $55 | $60 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $40 | $47 | $54 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $73 | $75 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $65 | $65 | $65 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $106 | $113 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $104 | $104 | $104 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $159 | $159 | $159 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $83 | $83 | $83 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $78 | $78 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $92 | $92 | $92 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $130 | $130 | $130 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $138 | $138 | $138 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $108 | $108 | $108 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $213 | $213 | $213 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $185 | $185 | $185 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $44 | $44 | $44 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $108 | $108 | $108 |
| EMG needle each extremity complete CPT 95886 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $49 | $49 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $110 | $110 | $110 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $132 | $132 | $132 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $99 | $99 | $99 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $110 | $110 | $110 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $43 | $58 | $66 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $69 | $111 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $136 | $152 | $169 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $170 | $172 | $175 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $21 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $22 | $35 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $51 | $85 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $88 | $102 | $129 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $105 | $168 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $71 | $78 | $85 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $114 | $116 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $166 | $171 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $38 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $58 | $60 | $62 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $89 | $96 | $103 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $61 | $68 | $75 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $89 | $98 | $106 |
| Consultation office straightforward CPT 99241 • Office Visits | $43 | $43 | $43 |
| Consultation office low complexity CPT 99243 • Office Visits | $88 | $88 | $88 |
| Consultation office high complexity CPT 99245 • Office Visits | $174 | $174 | $174 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $565 | $565 | $565 |