| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $107 | $107 | $107 |
| Interactive complexity add-on CPT 90785 • Mental Health | $8 | $8 | $8 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $188 | $188 | $188 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $199 | $199 | $199 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $79 | $79 | $79 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $54 | $54 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $129 | $129 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $89 | $89 | $89 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $156 | $156 | $156 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $174 | $174 | $174 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $257 | $257 | $257 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $133 | $133 | $133 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $108 | $108 | $108 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $135 | $135 | $135 |
| Group psychotherapy CPT 90853 • Mental Health | $46 | $46 | $46 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $225 | $225 | $225 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $249 | $249 | $249 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $149 | $149 | $149 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $158 | $158 | $158 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $124 | $124 | $124 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $63 | $63 | $63 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $104 | $104 | $104 |
| EMG needle each extremity complete CPT 95886 • Neurology | $63 | $63 | $63 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $58 | $58 | $58 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $101 | $101 | $101 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $186 | $186 | $186 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $245 | $245 | $245 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $244 | $244 | $244 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $67 | $67 | $67 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $133 | $133 | $133 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $189 | $189 | $189 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $215 | $215 | $215 |
| Office visit established patient minimal CPT 99211 • Office Visits | $26 | $26 | $26 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $33 | $33 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $71 | $71 | $71 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $84 | $84 | $84 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $186 | $186 | $186 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $97 | $97 | $97 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $176 | $176 | $176 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $223 | $223 | $223 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $49 | $49 | $49 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $80 | $80 | $80 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $132 | $132 | $132 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $99 | $99 | $99 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $137 | $137 | $137 |
| Consultation office straightforward CPT 99241 • Office Visits | $54 | $54 | $54 |
| Consultation office low complexity CPT 99243 • Office Visits | $134 | $134 | $134 |
| Consultation office high complexity CPT 99245 • Office Visits | $287 | $287 | $287 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $883 | $883 | $883 |