| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $34 | $34 | $34 |
| Interactive complexity add-on CPT 90785 • Mental Health | $5 | $5 | $5 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $163 | $163 | $163 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $132 | $132 | $132 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $54 | $54 | $54 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $45 | $45 | $45 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $88 | $88 | $88 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $74 | $74 | $74 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $129 | $129 | $129 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $119 | $119 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $177 | $177 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $92 | $92 | $92 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $103 | $103 | $103 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $143 | $143 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $116 | $116 | $116 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $108 | $108 | $108 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $198 | $198 | $198 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $200 | $200 | $200 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $79 | $79 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $109 | $109 | $109 |
| EMG needle each extremity complete CPT 95886 • Neurology | $41 | $41 | $41 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $100 | $100 | $100 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $123 | $123 | $123 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $64 | $64 | $64 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $195 | $195 | $195 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $321 | $321 | $321 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $67 | $85 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $36 | $61 | $86 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $36 | $68 | $133 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $137 | $137 | $137 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $27 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $36 | $36 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $36 | $43 | $57 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $36 | $53 | $86 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $36 | $64 | $91 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $82 | $82 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $113 | $113 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $167 | $167 | $167 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $34 | $34 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $88 | $88 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $36 | $45 | $63 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $90 | $90 |
| Consultation office straightforward CPT 99241 • Office Visits | $45 | $45 | $45 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $116 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $211 | $211 | $211 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $552 | $552 | $552 |