| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $181 | $181 | $181 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $74 | $74 | $74 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $100 | $100 | $100 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $136 | $136 | $136 |
| Group psychotherapy CPT 90853 • Mental Health | $62 | $62 | $62 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $117 | $117 | $118 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $531 | $531 | $531 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $639 | $639 | $639 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $88 | $126 | $163 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $128 | $128 | $128 |
| EMG needle each extremity complete CPT 95886 • Neurology | $139 | $139 | $139 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $128 | $128 | $128 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $88 | $125 | $162 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $253 | $253 | $253 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $406 | $406 | $406 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $138 | $138 | $138 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $53 | $81 | $108 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $53 | $110 | $166 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $95 | $95 | $95 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $53 | $53 | $53 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $185 | $185 | $185 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $217 | $217 | $217 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $116 | $116 | $116 |
| Consultation office low complexity CPT 99243 • Office Visits | $120 | $120 | $121 |
| Consultation office high complexity CPT 99245 • Office Visits | $242 | $242 | $242 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,757 | $1,757 | $1,757 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $507 | $507 | $507 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,185 | $1,185 | $1,185 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $341 | $341 | $341 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $815 | $815 | $815 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $100 | $100 | $100 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $59 | $59 | $59 |
| Visual field examination CPT 92083 • Ophthalmology | $42 | $42 | $42 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $10 | $10 | $10 |
| Arthrocentesis aspiration small joint CPT 20600 • Orthopedics | $29 | $29 | $29 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $46 | $46 | $46 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $37 | $46 | $55 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,119 | $2,119 | $2,119 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,501 | $1,501 | $1,502 |
| Total shoulder replacement CPT 23472 • Orthopedics | $1,199 | $1,199 | $1,199 |
| Reverse total shoulder replacement CPT 23473 • Orthopedics | $1,335 | $1,335 | $1,335 |
| Closed treatment distal radial fracture CPT 25600 • Orthopedics | $279 | $279 | $279 |
| Total knee replacement CPT 27447 • Orthopedics | $1,062 | $1,062 | $1,062 |
| Open treatment tibial shaft fracture CPT 27756 • Orthopedics | $488 | $488 | $488 |
| Bunionectomy with osteotomy CPT 28296 • Orthopedics | $766 | $766 | $766 |
| Arthroscopy shoulder decompression CPT 29826 • Orthopedics | $141 | $141 | $141 |
| Arthroscopy knee with meniscectomy CPT 29881 • Orthopedics | $455 | $455 | $455 |
| Arthroscopy knee with meniscus repair CPT 29882 • Orthopedics | $576 | $576 | $576 |