| Obstetric ultrasound first trimester CPT 76801 • Maternity | $82 | $82 | $82 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $136 | $136 | $136 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $106 | $106 | $106 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $55 | $55 | $55 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $41 | $41 | $41 |
| Interactive complexity add-on CPT 90785 • Mental Health | $6 | $6 | $6 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $146 | $146 | $146 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $151 | $151 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $61 | $61 | $61 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $51 | $51 | $51 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $92 | $92 | $92 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $84 | $84 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $139 | $139 | $139 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $136 | $136 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $204 | $204 | $204 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $105 | $105 | $105 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $107 | $107 | $107 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $131 | $131 | $131 |
| Group psychotherapy CPT 90853 • Mental Health | $35 | $35 | $35 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $365 | $427 | $559 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $180 | $339 | $419 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $50 | $240 | $365 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $104 | $104 | $104 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $41 | $41 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $31 | $31 | $31 |
| EMG needle each extremity complete CPT 95886 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $64 | $64 | $64 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $61 | $61 | $61 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $73 | $73 | $73 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $94 | $94 | $94 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $229 | $229 | $229 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $52 | $67 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $32 | $56 | $106 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $32 | $78 | $129 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $32 | $138 | $192 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $27 | $30 | $32 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $32 | $34 | $40 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $32 | $46 | $91 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $132 | $132 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $76 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $126 | $126 | $126 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $175 | $175 | $175 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $38 | $38 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $62 | $62 | $62 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $88 | $88 | $88 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $79 | $79 | $79 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $107 | $107 | $107 |