| Obstetric ultrasound first trimester CPT 76801 • Maternity | $209 | $209 | $209 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $89 | $89 | $89 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $308 | $308 | $308 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $58 | $58 | $58 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $164 | $164 | $164 |
| Interactive complexity add-on CPT 90785 • Mental Health | $25 | $25 | $25 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $227 | $227 | $227 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $254 | $254 | $254 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $111 | $111 | $111 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $114 | $114 | $114 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $147 | $147 | $147 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $220 | $220 | $220 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $178 | $178 | $178 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $185 | $185 | $185 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $45 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $9 | $9 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $271 | $271 | $271 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $333 | $333 | $333 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $210 | $210 | $210 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $100 | $100 | $100 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $678 | $678 | $678 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $90 | $90 | $90 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $142 | $142 | $142 |
| EMG needle each extremity complete CPT 95886 • Neurology | $80 | $80 | $80 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $211 | $211 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $250 | $250 | $250 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $186 | $186 | $186 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $325 | $325 | $325 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $126 | $126 | $126 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $183 | $183 | $183 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $280 | $280 | $280 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $352 | $352 | $352 |
| Office visit established patient minimal CPT 99211 • Office Visits | $33 | $33 | $33 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $74 | $74 | $74 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $123 | $123 | $123 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $183 | $183 | $183 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $247 | $247 | $247 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $174 | $174 | $174 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $236 | $236 | $236 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $349 | $349 | $349 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $67 | $67 | $67 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $125 | $125 | $125 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $179 | $179 | $179 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $125 | $125 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $184 | $184 | $184 |
| Consultation office low complexity CPT 99243 • Office Visits | $212 | $212 | $212 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,543 | $1,543 | $1,543 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,022 | $2,022 | $2,022 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $860 | $860 | $860 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,040 | $2,040 | $2,040 |