| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $126 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $40 | $50 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $6 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $155 | $155 | $155 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $338 | $344 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $379 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $66 | $93 | $119 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $174 | $174 | $174 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $96 | $96 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $120 | $120 | $120 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $79 | $91 | $102 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $129 | $146 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $169 | $195 | $221 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $56 | $144 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $20 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $57 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $61 | $90 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $129 | $150 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $168 | $181 | $195 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $65 | $65 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $103 | $144 | $186 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $145 | $160 | $183 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $47 | $47 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $84 | $100 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $93 | $93 | $93 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $86 | $100 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $77 | $90 | $103 |
| Consultation office low complexity CPT 99243 • Office Visits | $136 | $136 | $137 |
| Consultation office high complexity CPT 99245 • Office Visits | $29 | $29 | $29 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $758 | $758 | $758 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $245 | $245 | $245 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $60 | $60 | $60 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $296 | $296 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $663 | $663 | $663 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $508 | $508 | $508 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $119 | $119 | $119 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $541 | $541 | $541 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $357 | $382 | $407 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $106 | $106 | $106 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $101 | $124 | $147 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $54 | $71 | $88 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $81 | $103 | $124 |
| Visual field examination CPT 92083 • Ophthalmology | $37 | $49 | $62 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $26 | $26 | $26 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $44 | $44 | $44 |
| Fundus photography CPT 92250 • Ophthalmology | $17 | $27 | $36 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $38 | $38 | $38 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $7 | $36 | $66 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,946 | $1,946 | $1,946 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,907 | $1,907 | $1,907 |