| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $100 | $100 | $100 |
| Interactive complexity add-on CPT 90785 • Mental Health | $18 | $18 | $18 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $132 | $172 | $210 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $235 | $235 | $235 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $95 | $95 | $95 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $111 | $111 | $111 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $110 | $110 | $110 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $131 | $158 | $186 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $146 | $146 | $146 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $179 | $179 | $179 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $88 | $88 | $88 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $119 | $119 | $119 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $100 | $113 | $125 |
| Group psychotherapy CPT 90853 • Mental Health | $34 | $34 | $34 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $170 | $170 | $170 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $161 | $161 | $161 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $161 | $161 | $161 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $459 | $459 | $459 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $461 | $461 | $461 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $72 | $72 | $72 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $96 | $96 | $96 |
| EMG needle each extremity complete CPT 95886 • Neurology | $113 | $113 | $113 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $62 | $62 | $62 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $132 | $132 | $132 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $93 | $93 | $93 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $124 | $124 | $124 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $338 | $338 | $338 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $79 | $95 | $102 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $89 | $121 | $152 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $107 | $154 | $183 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $188 | $201 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $10 | $10 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $60 | $61 | $62 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $79 | $83 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $83 | $100 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $158 | $174 | $190 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $90 | $144 | $171 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $143 | $143 | $143 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $190 | $190 | $190 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $54 | $54 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $86 | $86 | $86 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $130 | $130 |
| 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 | $125 | $125 | $125 |
| Consultation office straightforward CPT 99241 • Office Visits | $104 | $104 | $104 |
| Consultation office low complexity CPT 99243 • Office Visits | $123 | $123 | $123 |
| Consultation office high complexity CPT 99245 • Office Visits | $198 | $198 | $198 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $601 | $626 | $651 |