| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $138 | $138 | $138 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $129 | $129 | $129 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $162 | $162 | $162 |
| Group psychotherapy CPT 90853 • Mental Health | $46 | $46 | $46 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $246 | $246 | $246 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $263 | $263 | $263 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $158 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $71 | $116 | $194 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $216 | $331 | $447 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $144 | $144 | $144 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $208 | $208 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $66 | $79 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $80 | $80 | $80 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $60 | $102 | $185 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $77 | $89 | $102 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $103 | $117 | $131 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $292 | $385 | $479 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $75 | $94 | $112 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $84 | $123 | $161 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $33 | $117 | $194 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $202 | $237 | $306 |
| Office visit established patient minimal CPT 99211 • Office Visits | $32 | $32 | $33 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $34 | $39 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $62 | $85 | $108 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $33 | $82 | $116 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $142 | $153 | $165 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $85 | $117 | $149 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $140 | $171 | $202 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $191 | $226 | $298 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $51 | $59 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $88 | $107 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $97 | $125 | $153 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $82 | $94 | $107 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $125 | $157 |
| Consultation office low complexity CPT 99243 • Office Visits | $144 | $144 | $144 |
| Consultation office high complexity CPT 99245 • Office Visits | $334 | $334 | $334 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $857 | $857 | $857 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $104 | $104 | $104 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,727 | $1,727 | $1,727 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $513 | $513 | $513 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,786 | $1,786 | $1,786 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $938 | $938 | $938 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $499 | $499 | $499 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,595 | $1,595 | $1,595 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,149 | $1,149 | $1,149 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $202 | $202 | $202 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $2,406 | $2,406 | $2,406 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,002 | $1,002 | $1,002 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,771 | $1,771 | $1,771 |