| Family psychotherapy with patient CPT 90847 • Mental Health | $173 | $173 | $173 |
| Group psychotherapy CPT 90853 • Mental Health | $63 | $63 | $63 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $232 | $232 | $232 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $107 | $115 | $124 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $251 | $251 | $251 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $340 | $340 | $340 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $408 | $408 | $408 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $109 | $109 | $109 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $158 | $158 | $158 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $93 | $93 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $87 | $87 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $110 | $110 | $111 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $174 | $174 | $174 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $281 | $281 | $281 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $100 | $105 | $109 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $168 | $168 | $168 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $162 | $171 | $179 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $209 | $271 | $332 |
| Office visit established patient minimal CPT 99211 • Office Visits | $32 | $33 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $78 | $81 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $125 | $131 | $136 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $116 | $147 | $177 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $271 | $271 | $271 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $150 | $156 | $162 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $202 | $202 | $202 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $273 | $285 | $297 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $58 | $58 | $58 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $107 | $115 | $123 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $141 | $147 | $153 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $107 | $115 | $123 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $150 | $153 | $157 |
| Consultation office low complexity CPT 99243 • Office Visits | $139 | $157 | $174 |
| Consultation office high complexity CPT 99245 • Office Visits | $314 | $321 | $328 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,131 | $1,131 | $1,131 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $71 | $71 | $71 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,126 | $2,126 | $2,126 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,970 | $1,970 | $1,970 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $471 | $689 | $907 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $542 | $542 | $542 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,344 | $1,344 | $1,344 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $981 | $981 | $981 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $166 | $166 | $166 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $931 | $931 | $931 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $213 | $414 | $614 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $869 | $869 | $869 |
| Excision chalazion single CPT 67800 • Ophthalmology | $233 | $233 | $233 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $750 | $750 | $750 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $268 | $268 | $268 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $79 | $79 | $79 |