| Obstetric ultrasound first trimester CPT 76801 • Maternity | $45 | $45 | $45 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $45 | $45 | $45 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $190 | $190 | $190 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $41 | $41 | $41 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $64 | $64 | $64 |
| Interactive complexity add-on CPT 90785 • Mental Health | $17 | $17 | $17 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $140 | $156 | $172 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $172 | $172 | $172 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $57 | $63 | $69 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $85 | $85 | $85 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $110 | $112 | $113 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $120 | $120 | $120 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $142 | $151 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $138 | $138 | $138 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $100 | $100 | $100 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $130 | $130 | $130 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $33 | $41 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $41 | $41 | $41 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $41 | $41 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $112 | $112 | $112 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $303 | $303 | $303 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $51 | $51 | $51 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $130 | $130 | $130 |
| EMG needle each extremity complete CPT 95886 • Neurology | $84 | $84 | $84 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $51 | $51 | $51 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $176 | $176 | $176 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $288 | $288 | $288 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $41 | $65 | $90 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $41 | $90 | $140 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $41 | $135 | $228 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $242 | $304 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $26 | $41 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $41 | $59 | $76 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $41 | $82 | $123 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $41 | $108 | $175 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $41 | $145 | $248 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $41 | $41 | $41 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $41 | $41 | $41 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $41 | $41 | $41 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $41 | $41 | $41 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $41 | $41 | $41 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $41 | $41 | $41 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $41 | $41 | $41 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $100 | $100 | $100 |
| Consultation office low complexity CPT 99243 • Office Visits | $83 | $83 | $83 |
| Consultation office high complexity CPT 99245 • Office Visits | $41 | $41 | $41 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $41 | $41 | $41 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $41 | $41 | $41 |