| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $140 | $140 | $140 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $144 | $144 | $144 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $137 | $160 | $183 |
| Group psychotherapy CPT 90853 • Mental Health | $32 | $40 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $149 | $175 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $256 | $256 | $256 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $217 | $217 | $217 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $92 | $239 | $387 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $92 | $311 | $531 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $84 | $84 | $84 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $199 | $199 | $199 |
| EMG needle each extremity complete CPT 95886 • Neurology | $101 | $107 | $113 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $119 | $119 | $119 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $148 | $148 | $148 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $161 | $234 | $308 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $167 | $189 | $211 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $646 | $646 | $646 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $88 | $98 | $107 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $138 | $148 | $157 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $208 | $224 | $240 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $227 | $264 | $301 |
| Office visit established patient minimal CPT 99211 • Office Visits | $15 | $21 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $65 | $67 | $69 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $93 | $113 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $121 | $138 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $210 | $217 | $224 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $103 | $125 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $163 | $182 | $202 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $217 | $257 | $297 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $99 | $104 | $109 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $148 | $152 | $157 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $101 | $106 | $112 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $143 | $152 | $161 |
| Consultation office low complexity CPT 99243 • Office Visits | $161 | $161 | $161 |
| Consultation office high complexity CPT 99245 • Office Visits | $382 | $382 | $382 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $917 | $917 | $917 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $76 | $76 | $76 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,811 | $1,811 | $1,811 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $495 | $495 | $495 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,668 | $1,668 | $1,668 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $887 | $887 | $887 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $646 | $646 | $646 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,522 | $1,522 | $1,522 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $661 | $872 | $1,083 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $314 | $314 | $314 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $2,273 | $2,273 | $2,273 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $982 | $982 | $982 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,661 | $1,661 | $1,661 |