| Psychotherapy 45 minutes CPT 90834 • Mental Health | $76 | $94 | $129 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $68 | $89 | $107 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $119 | $138 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $134 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $176 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $52 | $62 | $71 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $80 | $93 | $107 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $81 | $114 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $77 | $77 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $124 | $124 | $124 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $122 | $122 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $341 | $345 | $350 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $109 | $109 | $109 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $158 | $158 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $133 | $133 | $133 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $174 | $174 | $174 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $282 | $282 | $282 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $70 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $106 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $155 | $160 | $162 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $143 | $176 | $209 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $3 | $28 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $80 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $107 | $113 | $116 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $102 | $139 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $128 | $149 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $170 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $167 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $86 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $90 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $104 | $116 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $73 | $101 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $80 | $80 |
| Consultation office low complexity CPT 99243 • Office Visits | $139 | $139 | $139 |
| Consultation office high complexity CPT 99245 • Office Visits | $223 | $223 | $223 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,021 | $1,021 | $1,021 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $471 | $471 | $471 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $509 | $509 | $509 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $107 | $107 | $107 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,116 | $1,116 | $1,116 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $483 | $483 | $483 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $213 | $213 | $213 |
| Excision chalazion single CPT 67800 • Ophthalmology | $121 | $121 | $121 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $772 | $772 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $82 | $82 | $82 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $116 | $116 | $117 |