| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $28 | $28 | $28 |
| Interactive complexity add-on CPT 90785 • Mental Health | $11 | $11 | $11 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $103 | $103 | $103 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $50 | $50 | $50 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $49 | $49 | $49 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $94 | $94 | $94 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $87 | $87 | $87 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $105 | $105 | $105 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $47 | $47 | $47 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $84 | $84 | $84 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $20 | $20 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $108 | $108 | $108 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $97 | $97 | $97 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $80 | $80 | $80 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $260 | $260 | $260 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $305 | $305 | $305 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $49 | $49 | $49 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $62 | $62 | $62 |
| EMG needle each extremity complete CPT 95886 • Neurology | $34 | $34 | $34 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $40 | $40 | $40 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $108 | $108 | $108 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $142 | $142 | $142 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $80 | $80 | $80 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $55 | $55 | $55 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $56 | $56 | $56 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $120 | $120 | $120 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $151 | $151 | $151 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $16 | $16 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $33 | $33 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $54 | $54 | $54 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $79 | $79 | $79 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $106 | $106 | $106 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $74 | $74 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $101 | $101 | $101 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $149 | $149 | $149 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $29 | $29 | $29 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $54 | $54 | $54 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $77 | $77 | $77 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $54 | $54 | $54 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $79 | $79 | $79 |
| Consultation office straightforward CPT 99241 • Office Visits | $24 | $24 | $24 |
| Consultation office low complexity CPT 99243 • Office Visits | $90 | $90 | $90 |
| Consultation office high complexity CPT 99245 • Office Visits | $164 | $164 | $164 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $446 | $446 | $446 |