| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $58 | $58 | $58 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $93 | $93 | $93 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $96 | $96 | $96 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $23 | $23 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $111 | $111 | $111 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $103 | $114 | $124 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $142 | $142 | $142 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $44 | $44 | $44 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $339 | $339 | $339 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $79 | $109 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $132 | $145 | $158 |
| EMG needle each extremity complete CPT 95886 • Neurology | $96 | $96 | $96 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $43 | $43 | $43 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $115 | $119 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $112 | $112 | $112 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $117 | $117 | $117 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $73 | $73 | $73 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $86 | $86 | $86 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $147 | $162 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $129 | $169 | $209 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $18 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $21 | $21 | $21 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $57 | $57 | $57 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $60 | $88 | $116 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $111 | $111 | $111 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $78 | $78 | $78 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $129 | $129 | $129 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $151 | $153 | $155 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $59 | $59 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $86 | $86 | $86 |
| 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 | $80 | $81 | $82 |
| Consultation office low complexity CPT 99243 • Office Visits | $74 | $96 | $118 |
| Consultation office high complexity CPT 99245 • Office Visits | $213 | $218 | $223 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $495 | $495 | $495 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $35 | $35 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $905 | $905 | $905 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $199 | $199 | $199 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $883 | $883 | $883 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $385 | $503 | $621 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $324 | $324 | $324 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $607 | $607 | $607 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $442 | $442 | $442 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $82 | $82 | $82 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,264 | $1,264 | $1,264 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $397 | $397 | $397 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $213 | $289 | $364 |