| Family psychotherapy without patient CPT 90846 • Mental Health | $95 | $124 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $133 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $59 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $338 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $111 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $95 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $67 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $100 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $144 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $210 | $213 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $54 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $59 | $75 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $86 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $171 | $173 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $86 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $112 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $173 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $79 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $72 | $110 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $81 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $68 | $110 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $116 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $97 | $170 |
| Consultation office high complexity CPT 99245 • Office Visits | $172 | $227 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $30 | $30 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $30 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $482 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $288 | $288 | $288 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $276 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $30 | $30 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $30 | $30 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $30 | $30 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $772 | $772 |