| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $122 | $122 | $122 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $65 | $104 | $140 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $83 | $162 | $263 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $55 | $60 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $54 | $54 | $54 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $55 | $67 | $91 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $94 | $94 | $94 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $80 | $97 | $113 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $91 | $91 | $91 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $96 | $96 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $55 | $65 | $76 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $18 | $18 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $85 | $85 | $85 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $407 | $407 | $407 |
| EMG needle each extremity complete CPT 95886 • Neurology | $86 | $86 | $86 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $112 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $73 | $73 | $73 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $262 | $262 | $262 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $56 | $56 | $56 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $106 | $106 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $185 | $185 | $185 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $304 | $304 | $304 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $20 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $56 | $56 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $55 | $88 | $149 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $129 | $129 | $129 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $156 | $156 | $156 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $198 | $198 | $198 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $264 | $264 | $264 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $75 | $75 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $120 | $120 | $120 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $153 | $153 | $153 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $123 | $123 | $123 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $143 | $143 | $143 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $496 | $496 | $496 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $109 | $109 | $109 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $492 | $492 | $492 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $324 | $324 | $324 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $115 | $115 | $115 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $26 | $26 | $26 |
| Fundus photography CPT 92250 • Ophthalmology | $34 | $34 | $34 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $80 | $80 | $80 |
| Carpal tunnel release CPT 64721 • Orthopedics | $535 | $535 | $535 |
| Sacroiliac joint injection CPT 27096 • Pain Management | $150 | $150 | $150 |
| Epidural injection cervical or thoracic with imaging CPT 62321 • Pain Management | $260 | $260 | $260 |
| Epidural injection lumbar or sacral with imaging CPT 62323 • Pain Management | $257 | $257 | $257 |
| Epidural injection lumbar or sacral transforaminal CPT 64483 • Pain Management | $374 | $374 | $374 |
| Epidural injection lumbar each additional level CPT 64484 • Pain Management | $111 | $111 | $111 |
| Facet joint injection lumbar first level CPT 64493 • Pain Management | $269 | $269 | $269 |