| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $141 | $141 | $141 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $66 | $66 | $66 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $76 | $76 | $76 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $247 | $247 | $247 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $277 | $277 | $277 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $100 | $100 | $100 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $97 | $97 | $97 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $133 | $133 | $133 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $148 | $148 | $148 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $188 | $188 | $188 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $170 | $170 | $170 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $222 | $222 | $222 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $111 | $111 | $111 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $146 | $146 | $146 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $151 | $151 | $151 |
| Group psychotherapy CPT 90853 • Mental Health | $65 | $65 | $65 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $194 | $194 | $194 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $371 | $371 | $371 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $436 | $436 | $436 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $110 | $110 | $110 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $159 | $159 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $110 | $110 | $110 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $132 | $132 | $132 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $173 | $173 | $173 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $280 | $280 | $280 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $91 | $91 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $143 | $143 | $143 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $215 | $215 | $215 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $283 | $283 | $283 |
| Office visit established patient minimal CPT 99211 • Office Visits | $29 | $29 | $29 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $72 | $72 | $72 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $117 | $117 | $117 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $164 | $164 | $164 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $231 | $231 | $231 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $105 | $105 | $105 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $166 | $166 | $166 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $222 | $222 | $222 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $63 | $63 | $63 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $101 | $101 | $101 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $151 | $151 | $151 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $103 | $103 | $103 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $146 | $146 | $146 |
| Consultation office low complexity CPT 99243 • Office Visits | $144 | $144 | $144 |
| Consultation office high complexity CPT 99245 • Office Visits | $268 | $268 | $268 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $870 | $870 | $870 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $341 | $341 | $341 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $412 | $412 | $412 |