| Family psychotherapy without patient CPT 90846 • Mental Health | $84 | $84 | $84 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $102 | $102 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $28 | $28 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $58 | $58 | $58 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $147 | $147 | $147 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $109 | $109 | $109 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $157 | $157 | $157 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $53 | $53 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $79 | $79 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $24 | $24 | $24 |
| EMG needle each extremity complete CPT 95886 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $63 | $63 | $63 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $57 | $57 | $57 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $73 | $73 | $73 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $108 | $108 | $108 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $56 | $64 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $59 | $85 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $99 | $124 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $150 | $188 | $225 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $19 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $43 | $52 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $53 | $85 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $70 | $96 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $83 | $124 | $165 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $59 | $68 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $96 | $97 | $98 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $137 | $149 | $161 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $36 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $49 | $74 | $99 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $69 | $86 | $103 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $62 | $68 | $75 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $84 | $95 | $106 |
| Consultation office low complexity CPT 99243 • Office Visits | $105 | $105 | $105 |
| Consultation office high complexity CPT 99245 • Office Visits | $193 | $193 | $193 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $453 | $453 | $453 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $55 | $55 | $55 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $901 | $901 | $901 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $233 | $233 | $233 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $812 | $812 | $812 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $435 | $435 | $435 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $319 | $319 | $319 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $784 | $784 | $784 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $323 | $457 | $590 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $103 | $138 | $174 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,185 | $1,185 | $1,185 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $517 | $517 | $517 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $716 | $716 | $716 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $424 | $424 | $424 |