| Obstetric ultrasound first trimester CPT 76801 • Maternity | $107 | $149 | $190 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $129 | $183 | $237 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $174 | $202 | $230 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $74 | $105 | $135 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $153 | $153 | $153 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $205 | $205 | $205 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $134 | $134 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $325 | $325 | $325 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $152 | $152 | $152 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $274 | $274 | $274 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $86 | $86 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $68 | $68 | $68 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $164 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $219 | $219 | $219 |
| Office visit established patient minimal CPT 99211 • Office Visits | $267 | $267 | $267 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $54 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $94 | $94 | $94 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $184 | $184 | $184 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $162 | $162 | $162 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $87 | $87 | $87 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $119 | $119 | $119 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $158 | $158 | $158 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $38 | $38 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $87 | $87 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $96 | $96 | $96 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $141 | $141 | $141 |
| Consultation office low complexity CPT 99243 • Office Visits | $112 | $112 | $112 |
| Consultation office high complexity CPT 99245 • Office Visits | $197 | $197 | $197 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $257 | $257 | $257 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $436 | $436 | $436 |
| Visual field examination CPT 92083 • Ophthalmology | $59 | $59 | $59 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $72 | $72 | $72 |
| Laminectomy lumbar single level CPT 63047 • Orthopedics | $1,354 | $1,354 | $1,354 |
| Chemodenervation of muscle migraine CPT 64615 • Pain Management | $134 | $134 | $134 |
| Cytopathology concentration technique CPT 88108 • Pathology | $117 | $117 | $117 |
| Cytopathology cell enhancement technique CPT 88112 • Pathology | $12 | $59 | $106 |
| Cytopathology cervical/vaginal interpretation physician CPT 88141 • Pathology | $11 | $27 | $42 |
| Cytopathology cervical/vaginal manual screen CPT 88164 • Pathology | $45 | $45 | $45 |
| Cytopathology cervical/vaginal automated thin layer CPT 88175 • Pathology | $12 | $41 | $70 |
| Molecular cytogenetics DNA probe each CPT 88271 • Pathology | $56 | $56 | $56 |
| Cytogenetics molecular interpretation CPT 88291 • Pathology | $60 | $60 | $60 |
| Surgical pathology gross and micro exam level II CPT 88302 • Pathology | $3 | $36 | $69 |
| Surgical pathology gross and micro exam level III CPT 88304 • Pathology | $5 | $44 | $83 |
| Surgical pathology gross and micro exam level IV CPT 88305 • Pathology | $17 | $55 | $92 |
| Surgical pathology gross and micro exam level V CPT 88307 • Pathology | $36 | $296 | $555 |