| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $92 | $92 | $92 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $96 | $96 | $96 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $120 | $120 |
| Group psychotherapy CPT 90853 • Mental Health | $34 | $34 | $34 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $289 | $289 | $289 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $281 | $281 | $281 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $224 | $224 | $224 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $61 | $61 | $61 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $232 | $232 | $232 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $49 | $49 | $49 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $89 | $89 | $89 |
| EMG needle each extremity complete CPT 95886 • Neurology | $59 | $59 | $59 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $63 | $63 | $63 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $81 | $81 | $81 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $130 | $130 | $130 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $173 | $173 | $173 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $48 | $48 | $48 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $107 | $107 | $107 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $160 | $177 | $195 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $200 | $200 | $200 |
| Office visit established patient minimal CPT 99211 • Office Visits | $25 | $25 | $25 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $25 | $25 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $46 | $46 | $46 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $104 | $121 | $137 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $105 | $105 | $105 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $92 | $92 | $92 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $130 | $130 | $130 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $190 | $241 | $292 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $39 | $39 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $70 | $70 | $70 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $99 | $99 | $99 |
| 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 | $105 | $105 | $105 |
| Consultation office low complexity CPT 99243 • Office Visits | $141 | $141 | $141 |
| Consultation office high complexity CPT 99245 • Office Visits | $254 | $254 | $254 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $686 | $686 | $686 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $66 | $66 | $66 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,537 | $1,537 | $1,537 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $457 | $457 | $457 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,487 | $1,487 | $1,487 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $789 | $789 | $789 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $514 | $514 | $514 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,341 | $1,341 | $1,341 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $963 | $963 | $963 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $290 | $290 | $290 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $2,000 | $2,000 | $2,000 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $869 | $869 | $869 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,383 | $1,383 | $1,383 |