| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $43 | $82 | $122 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $8 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $260 | $260 | $260 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $217 | $217 | $217 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $86 | $86 | $86 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $72 | $72 | $72 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $129 | $129 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $118 | $118 | $118 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $195 | $195 | $195 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $189 | $189 | $189 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $283 | $283 | $283 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $147 | $147 | $147 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $130 | $130 | $130 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $165 | $165 | $165 |
| Group psychotherapy CPT 90853 • Mental Health | $47 | $47 | $47 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $8 | $8 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $228 | $240 | $251 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $207 | $216 | $224 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $173 | $184 | $195 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $317 | $317 | $317 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $82 | $82 | $82 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $53 | $53 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $55 | $55 | $55 |
| EMG needle each extremity complete CPT 95886 • Neurology | $82 | $82 | $82 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $70 | $70 | $70 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $113 | $113 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $135 | $135 | $135 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $180 | $180 | $180 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $320 | $320 | $320 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $76 | $94 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $121 | $138 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $155 | $196 | $221 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $244 | $334 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $31 | $33 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $34 | $46 | $52 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $85 | $87 | $92 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $138 | $161 | $173 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $146 | $195 | $244 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $132 | $152 | $172 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $181 | $207 | $233 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $267 | $314 | $345 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $55 | $61 | $66 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $98 | $111 | $123 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $141 | $159 | $177 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $100 | $112 | $124 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $144 | $163 | $182 |
| Consultation office straightforward CPT 99241 • Office Visits | $35 | $35 | $35 |
| Consultation office low complexity CPT 99243 • Office Visits | $186 | $198 | $209 |
| Consultation office high complexity CPT 99245 • Office Visits | $338 | $359 | $381 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $852 | $868 | $884 |