| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $130 | $130 | $130 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $211 | $211 | $211 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $218 | $218 | $218 |
| Group psychotherapy CPT 90853 • Mental Health | $58 | $58 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $12 | $12 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $132 | $494 | $856 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $253 | $449 | $644 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $296 | $503 | $709 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $818 | $818 | $818 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $124 | $124 | $124 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $146 | $146 | $146 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $197 | $197 | $197 |
| EMG needle each extremity complete CPT 95886 • Neurology | $150 | $150 | $150 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $208 | $208 | $208 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $237 | $237 | $237 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $451 | $451 | $451 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $210 | $210 | $210 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $662 | $662 | $662 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $164 | $187 | $209 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $282 | $442 | $601 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $389 | $510 | $752 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $445 | $591 | $719 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $35 | $50 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $93 | $122 | $150 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $170 | $235 | $301 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $84 | $206 | $451 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $311 | $336 | $360 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $218 | $233 | $249 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $341 | $621 | $902 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $427 | $476 | $501 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $132 | $216 | $301 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $186 | $318 | $451 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $219 | $287 | $354 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $155 | $244 | $333 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $226 | $319 | $365 |
| Consultation office low complexity CPT 99243 • Office Visits | $265 | $330 | $362 |
| Consultation office high complexity CPT 99245 • Office Visits | $408 | $568 | $648 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,590 | $1,590 | $1,590 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $109 | $109 | $109 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,810 | $2,810 | $2,810 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $493 | $493 | $493 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,610 | $2,610 | $2,610 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,206 | $1,206 | $1,206 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $722 | $722 | $722 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,784 | $1,784 | $1,784 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,300 | $1,742 | $2,184 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $121 | $181 | $240 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $2,845 | $2,845 | $2,845 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,238 | $1,238 | $1,238 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $815 | $815 | $815 |