| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $60 | $60 | $60 |
| Interactive complexity add-on CPT 90785 • Mental Health | $7 | $7 | $7 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $216 | $216 | $216 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $160 | $167 | $174 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $90 | $90 | $90 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $60 | $60 | $60 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $116 | $116 | $116 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $97 | $97 | $97 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $170 | $170 | $170 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $156 | $156 | $156 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $239 | $239 | $239 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $124 | $124 | $124 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $118 | $118 | $118 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $146 | $146 | $146 |
| Group psychotherapy CPT 90853 • Mental Health | $43 | $43 | $43 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $102 | $102 | $102 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $187 | $187 | $187 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $163 | $163 | $163 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $73 | $73 | $73 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $72 | $72 | $72 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $45 | $45 | $45 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $55 | $55 | $55 |
| EMG needle each extremity complete CPT 95886 • Neurology | $124 | $124 | $124 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $72 | $72 | $72 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $198 | $198 | $198 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $149 | $149 | $149 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $429 | $429 | $429 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $83 | $87 | $89 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $121 | $126 | $130 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $153 | $174 | $199 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $237 | $249 | $259 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $11 | $11 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $48 | $52 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $60 | $77 | $86 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $94 | $106 | $122 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $131 | $160 | $211 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $118 | $130 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $102 | $145 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $222 | $250 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $46 | $52 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $84 | $89 | $92 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $84 | $116 | $132 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $61 | $73 | $84 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $107 | $124 |
| Consultation office straightforward CPT 99241 • Office Visits | $42 | $42 | $42 |
| Consultation office low complexity CPT 99243 • Office Visits | $122 | $122 | $122 |
| Consultation office high complexity CPT 99245 • Office Visits | $282 | $282 | $282 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $848 | $848 | $848 |