| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $78 | $78 | $78 |
| Interactive complexity add-on CPT 90785 • Mental Health | $14 | $14 | $14 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $118 | $118 | $118 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $151 | $152 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $68 | $68 | $68 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $80 | $80 | $80 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $132 | $132 | $132 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $123 | $123 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $139 | $139 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $52 | $52 | $52 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $106 | $106 | $106 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $111 | $111 | $111 |
| Group psychotherapy CPT 90853 • Mental Health | $49 | $49 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $121 | $121 | $121 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $123 | $124 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $122 | $122 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $340 | $340 | $340 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $408 | $408 | $408 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $109 | $109 | $109 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $158 | $158 | $158 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $93 | $93 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $87 | $87 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $110 | $110 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $132 | $132 | $132 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $174 | $174 | $174 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $281 | $281 | $281 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $74 | $74 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $106 | $106 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $162 | $162 | $162 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $156 | $183 | $209 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $22 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $49 | $49 | $49 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $80 | $80 | $80 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $116 | $116 | $116 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $159 | $159 | $159 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $127 | $127 | $127 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $136 | $136 | $136 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $176 | $201 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $72 | $72 | $72 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $72 | $72 | $72 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $103 | $103 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $72 | $72 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $94 | $107 |
| Consultation office low complexity CPT 99243 • Office Visits | $118 | $118 | $118 |
| Consultation office high complexity CPT 99245 • Office Visits | $222 | $222 | $223 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $482 | $482 | $482 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $37 | $37 |