| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $72 | $72 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $53 | $53 | $53 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $59 | $95 | $116 |
| Group psychotherapy CPT 90853 • Mental Health | $17 | $32 | $47 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $152 | $152 | $152 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $155 | $224 | $292 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $85 | $85 | $85 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $61 | $61 | $61 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $62 | $62 | $62 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $107 | $120 | $132 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $47 | $99 | $151 |
| EMG needle each extremity complete CPT 95886 • Neurology | $25 | $25 | $25 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $53 | $53 | $53 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $71 | $88 | $104 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $72 | $72 | $72 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $115 | $115 | $115 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $128 | $128 | $128 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $63 | $63 | $63 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $76 | $76 | $76 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $89 | $137 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $42 | $92 | $142 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $14 | $14 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $34 | $34 | $34 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $37 | $50 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $55 | $89 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $61 | $93 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $42 | $42 | $42 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $113 | $113 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $42 | $65 | $87 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $25 | $25 | $25 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $39 | $39 | $39 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $59 | $59 | $59 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $60 | $60 | $60 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $87 | $107 | $127 |
| Consultation office low complexity CPT 99243 • Office Visits | $49 | $99 | $149 |
| Consultation office high complexity CPT 99245 • Office Visits | $99 | $185 | $270 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $907 | $907 | $907 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $35 | $35 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $559 | $559 | $559 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $96 | $96 | $96 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $849 | $849 | $849 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $253 | $508 | $763 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $171 | $171 | $171 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $581 | $581 | $581 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $423 | $423 | $423 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $78 | $78 | $78 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $558 | $558 | $558 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $403 | $403 | $403 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $265 | $335 | $404 |