| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $58 | $58 | $58 |
| Interactive complexity add-on CPT 90785 • Mental Health | $9 | $9 | $9 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $77 | $77 | $77 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $86 | $86 | $86 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $38 | $38 | $38 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $44 | $44 | $44 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $57 | $57 | $57 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $50 | $50 | $50 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $76 | $76 | $76 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $73 | $73 | $73 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $89 | $89 | $89 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $42 | $42 | $42 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $62 | $62 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $64 | $64 | $64 |
| Group psychotherapy CPT 90853 • Mental Health | $15 | $15 | $15 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $39 | $39 | $39 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $83 | $83 | $83 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $83 | $83 | $83 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $223 | $223 | $223 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $36 | $36 | $36 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $41 | $41 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $54 | $54 | $54 |
| EMG needle each extremity complete CPT 95886 • Neurology | $31 | $31 | $31 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $59 | $59 | $59 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $42 | $42 | $42 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $39 | $39 | $39 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $117 | $117 | $117 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $186 | $186 | $186 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $31 | $31 | $31 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $66 | $103 | $140 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $26 | $108 | $199 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $26 | $52 | $104 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $14 | $14 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $16 | $36 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $46 | $64 | $82 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $26 | $33 | $48 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $89 | $122 | $155 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $62 | $62 | $62 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $84 | $84 | $84 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $124 | $124 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $24 | $24 | $24 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $44 | $44 | $44 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $64 | $64 | $64 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $45 | $45 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $65 | $65 | $65 |
| Consultation office straightforward CPT 99241 • Office Visits | $74 | $74 | $74 |
| Consultation office low complexity CPT 99243 • Office Visits | $76 | $76 | $76 |
| Consultation office high complexity CPT 99245 • Office Visits | $118 | $118 | $118 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $378 | $378 | $378 |