| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $43 | $43 | $43 |
| Interactive complexity add-on CPT 90785 • Mental Health | $7 | $7 | $7 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $211 | $211 | $211 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $171 | $171 | $171 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $88 | $88 | $88 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $59 | $59 | $59 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $114 | $114 | $114 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $95 | $95 | $95 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $167 | $167 | $167 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $154 | $154 | $154 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $230 | $230 | $230 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $119 | $119 | $119 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $112 | $112 | $112 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $134 | $134 | $134 |
| Group psychotherapy CPT 90853 • Mental Health | $42 | $42 | $42 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $103 | $103 | $103 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $194 | $194 | $194 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $150 | $150 | $150 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $309 | $309 | $309 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $267 | $267 | $267 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $44 | $44 | $44 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $157 | $157 | $157 |
| EMG needle each extremity complete CPT 95886 • Neurology | $66 | $66 | $66 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $59 | $59 | $59 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $162 | $162 | $162 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $85 | $85 | $85 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $255 | $255 | $255 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $162 | $162 | $162 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $65 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $129 | $201 | $272 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $163 | $163 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $212 | $388 | $522 |
| Office visit established patient minimal CPT 99211 • Office Visits | $12 | $12 | $12 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $51 | $74 | $113 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $113 | $187 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $125 | $176 | $274 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $139 | $254 | $368 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $97 | $161 | $258 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $172 | $260 | $349 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $253 | $428 | $516 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $50 | $90 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $91 | $135 | $186 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $175 | $265 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $89 | $89 | $89 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $131 | $131 | $131 |
| Consultation office straightforward CPT 99241 • Office Visits | $60 | $60 | $60 |
| Consultation office low complexity CPT 99243 • Office Visits | $165 | $165 | $165 |
| Consultation office high complexity CPT 99245 • Office Visits | $299 | $299 | $299 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $849 | $849 | $849 |