| Group psychotherapy CPT 90853 • Mental Health | $17 | $17 | $17 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $131 | $131 | $131 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $135 | $135 | $135 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $136 | $136 | $136 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $360 | $360 | $360 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $418 | $418 | $418 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $149 | $149 | $149 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $162 | $162 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $264 | $264 | $264 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $66 | $66 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $103 | $103 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $156 | $156 | $157 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $171 | $187 | $202 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $21 | $21 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $52 | $52 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $69 | $69 | $69 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $102 | $102 | $102 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $137 | $137 | $137 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $76 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $118 | $118 | $118 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $157 | $157 | $158 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $45 | $45 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $71 | $71 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $108 | $108 | $108 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $73 | $73 | $73 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $104 | $104 | $105 |
| Consultation office low complexity CPT 99243 • Office Visits | $110 | $110 | $110 |
| Consultation office high complexity CPT 99245 • Office Visits | $204 | $204 | $204 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $545 | $545 | $545 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $45 | $45 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,302 | $1,302 | $1,302 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $605 | $605 | $605 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $616 | $616 | $616 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $405 | $405 | $406 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $541 | $541 | $541 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $966 | $966 | $966 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $42 | $42 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $68 | $68 | $68 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $26 | $26 | $26 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $51 | $51 | $51 |
| Fundus photography CPT 92250 • Ophthalmology | $40 | $40 | $40 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $54 | $54 | $54 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $64 | $64 | $64 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $1,721 | $1,721 | $1,721 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $1,592 | $1,592 | $1,592 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,824 | $1,824 | $1,824 |