| Obstetric ultrasound limited CPT 76815 • Maternity | $28 | $28 | $28 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $33 | $33 | $33 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $124 | $124 | $124 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $121 | $121 | $121 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $60 | $60 | $60 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $62 | $62 | $62 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $80 | $80 | $80 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $79 | $79 | $79 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $120 | $120 | $120 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $103 | $103 | $103 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $125 | $125 | $125 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $60 | $60 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $87 | $87 | $87 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $91 | $91 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $24 | $24 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $320 | $415 | $559 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $180 | $303 | $365 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $180 | $288 | $365 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $316 | $316 | $316 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $375 | $375 | $375 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $104 | $104 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $77 | $77 | $77 |
| EMG needle each extremity complete CPT 95886 • Neurology | $84 | $84 | $84 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $126 | $126 | $126 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $72 | $72 | $72 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $165 | $165 | $165 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $56 | $65 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $32 | $61 | $86 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $147 | $171 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $32 | $134 | $192 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $20 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $22 | $30 | $37 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $32 | $49 | $70 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $32 | $77 | $131 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $126 | $126 | $126 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $88 | $88 | $88 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $119 | $119 | $119 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $175 | $175 | $175 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $34 | $34 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $63 | $63 | $63 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $90 | $90 | $90 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $63 | $63 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $93 | $93 |
| Consultation office straightforward CPT 99241 • Office Visits | $29 | $29 | $29 |
| Consultation office low complexity CPT 99243 • Office Visits | $84 | $84 | $84 |
| Consultation office high complexity CPT 99245 • Office Visits | $167 | $167 | $167 |