| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $125 | $125 | $125 |
| Interactive complexity add-on CPT 90785 • Mental Health | $20 | $20 | $20 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $185 | $185 | $185 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $191 | $191 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $91 | $91 | $91 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $88 | $88 | $88 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $112 | $112 | $112 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $118 | $118 | $118 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $169 | $169 | $169 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $156 | $156 | $156 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $176 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $84 | $84 | $84 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $136 | $136 | $136 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $141 | $141 | $141 |
| Group psychotherapy CPT 90853 • Mental Health | $33 | $33 | $33 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $194 | $194 | $194 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $175 | $175 | $175 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $143 | $143 | $143 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $78 | $78 | $78 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $472 | $472 | $472 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $69 | $69 | $69 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $111 | $111 | $111 |
| EMG needle each extremity complete CPT 95886 • Neurology | $62 | $62 | $62 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $126 | $126 | $126 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $108 | $108 | $108 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $145 | $145 | $145 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $255 | $255 | $255 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $67 | $67 | $67 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $101 | $101 | $101 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $163 | $183 | $215 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $211 | $271 |
| Office visit established patient minimal CPT 99211 • Office Visits | $12 | $12 | $12 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $59 | $59 | $59 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $68 | $79 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $85 | $113 | $142 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $150 | $171 | $191 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $134 | $134 | $134 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $181 | $181 | $181 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $268 | $268 | $268 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $52 | $52 | $52 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $96 | $96 | $96 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $138 | $138 | $138 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $97 | $97 | $97 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $142 | $142 | $142 |
| Consultation office straightforward CPT 99241 • Office Visits | $20 | $20 | $20 |
| Consultation office low complexity CPT 99243 • Office Visits | $161 | $161 | $161 |
| Consultation office high complexity CPT 99245 • Office Visits | $295 | $305 | $316 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $803 | $803 | $803 |