| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $31 | $77 | $122 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $115 | $119 | $122 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $122 | $129 | $136 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $56 | $61 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $40 | $47 | $54 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $78 | $79 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $66 | $80 | $94 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $116 | $124 | $133 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $91 | $99 | $106 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $128 | $159 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $83 | $83 | $83 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $74 | $74 | $74 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $84 | $93 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $23 | $26 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $128 | $128 | $128 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $126 | $126 | $126 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $110 | $110 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $85 | $132 | $178 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $52 | $93 | $134 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $42 | $42 | $42 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $67 | $67 | $67 |
| EMG needle each extremity complete CPT 95886 • Neurology | $83 | $85 | $86 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $50 | $50 | $50 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $48 | $80 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $57 | $65 | $73 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $74 | $74 | $74 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $180 | $221 | $262 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $53 | $55 | $56 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $57 | $80 | $103 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $44 | $97 | $119 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $123 | $179 | $234 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $17 | $17 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $32 | $59 | $86 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $52 | $85 | $118 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $55 | $77 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $105 | $190 | $275 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $74 | $74 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $102 | $135 | $168 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $44 | $126 | $264 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $31 | $53 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $55 | $89 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $79 | $91 | $103 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $56 | $77 | $100 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $112 | $143 |
| Consultation office straightforward CPT 99241 • Office Visits | $41 | $41 | $41 |
| Consultation office low complexity CPT 99243 • Office Visits | $105 | $105 | $105 |
| Consultation office high complexity CPT 99245 • Office Visits | $159 | $159 | $159 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $454 | $454 | $454 |