| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $265 | $265 | $265 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $385 | $385 | $385 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $398 | $398 | $398 |
| Group psychotherapy CPT 90853 • Mental Health | $91 | $91 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $21 | $21 | $21 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $227 | $227 | $227 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $423 | $452 | $480 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $421 | $421 | $421 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $1,266 | $1,266 | $1,266 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $226 | $226 | $226 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $279 | $552 | $824 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $325 | $750 | $1,176 |
| EMG needle each extremity complete CPT 95886 • Neurology | $313 | $313 | $313 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $373 | $373 | $373 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $168 | $497 | $826 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $284 | $284 | $284 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $1,544 | $1,544 | $1,544 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $1,517 | $1,517 | $1,517 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $129 | $129 | $129 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $277 | $277 | $277 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $389 | $410 | $432 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $490 | $518 | $545 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $66 | $66 | $66 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $130 | $130 | $130 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $143 | $256 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $339 | $339 | $339 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $257 | $257 | $257 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $346 | $346 | $346 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $505 | $514 | $524 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $98 | $98 | $98 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $180 | $180 | $180 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $259 | $259 | $259 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $183 | $183 | $183 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $267 | $272 | $277 |
| Consultation office low complexity CPT 99243 • Office Visits | $243 | $296 | $349 |
| Consultation office high complexity CPT 99245 • Office Visits | $483 | $559 | $634 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,786 | $1,786 | $1,786 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $141 | $141 | $141 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,642 | $3,642 | $3,642 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $766 | $766 | $766 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $3,383 | $3,383 | $3,383 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,538 | $1,550 | $1,563 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $936 | $936 | $936 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $2,312 | $2,312 | $2,312 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,685 | $1,685 | $1,685 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $312 | $312 | $312 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,687 | $3,687 | $3,687 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,605 | $1,605 | $1,605 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,040 | $1,048 | $1,057 |