| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $26 | $57 | $75 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $14 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $118 | $155 | $211 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $135 | $203 | $324 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $66 | $75 | $84 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $68 | $68 | $68 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $80 | $95 | $111 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $101 | $101 | $101 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $112 | $139 | $166 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $123 | $123 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $139 | $139 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $52 | $52 | $52 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $116 | $116 | $116 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $111 | $118 | $125 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $45 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $96 | $96 | $96 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $124 | $126 | $129 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $90 | $90 | $90 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $109 | $109 | $109 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $158 | $158 | $158 |
| EMG needle each extremity complete CPT 95886 • Neurology | $141 | $141 | $141 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $57 | $129 | $201 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $432 | $432 | $432 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $118 | $118 | $118 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $145 | $145 | $145 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $150 | $190 | $257 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $167 | $238 | $339 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $30 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $46 | $46 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $119 | $119 | $119 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $115 | $116 | $116 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $276 | $276 | $276 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $126 | $126 | $126 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $199 | $199 | $199 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $200 | $249 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $75 | $75 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $112 | $112 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $145 | $145 | $145 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $119 | $119 | $119 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $85 | $90 |
| Consultation office low complexity CPT 99243 • Office Visits | $118 | $118 | $118 |
| Consultation office high complexity CPT 99245 • Office Visits | $223 | $223 | $223 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $303 | $303 | $303 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $621 | $621 | $621 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $906 | $906 | $906 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $44 | $44 | $44 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $213 | $213 | $213 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $44 | $382 | $720 |