| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $27 | $87 | $148 |
| Interactive complexity add-on CPT 90785 • Mental Health | $22 | $22 | $22 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $110 | $164 | $218 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $202 | $244 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $76 | $99 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $63 | $83 | $103 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $109 | $142 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $131 | $131 | $131 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $111 | $162 | $213 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $184 | $184 | $184 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $222 | $222 | $222 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $107 | $107 | $107 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $171 | $171 | $171 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $178 | $178 | $178 |
| Group psychotherapy CPT 90853 • Mental Health | $39 | $39 | $39 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $122 | $122 | $122 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $182 | $182 | $182 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $202 | $202 | $202 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $551 | $551 | $551 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $556 | $556 | $556 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $104 | $104 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $266 | $266 | $266 |
| EMG needle each extremity complete CPT 95886 • Neurology | $146 | $146 | $146 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $63 | $63 | $63 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $107 | $107 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $128 | $128 | $128 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $130 | $130 | $130 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $170 | $170 | $170 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $92 | $117 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $95 | $166 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $104 | $201 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $137 | $262 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $22 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $52 | $69 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $65 | $85 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $79 | $168 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $140 | $225 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $117 | $158 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $96 | $155 | $213 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $238 | $315 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $73 | $93 | $113 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $133 | $162 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $94 | $114 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $137 | $167 |
| Consultation office straightforward CPT 99241 • Office Visits | $51 | $51 | $51 |
| Consultation office low complexity CPT 99243 • Office Visits | $150 | $150 | $150 |
| Consultation office high complexity CPT 99245 • Office Visits | $347 | $347 | $347 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $946 | $946 | $946 |