| Group psychotherapy CPT 90853 • Mental Health | $34 | $34 | $34 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $180 | $180 | $180 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $114 | $183 | $210 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $146 | $146 | $146 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $192 | $192 | $192 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $100 | $100 | $100 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $39 | $39 | $39 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $30 | $30 |
| EMG needle each extremity complete CPT 95886 • Neurology | $102 | $139 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $110 | $110 | $110 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $58 | $154 | $187 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $162 | $162 | $162 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $219 | $219 | $219 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $50 | $92 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $77 | $142 | $174 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $202 | $261 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $152 | $264 | $345 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $31 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $67 | $87 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $55 | $113 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $63 | $167 | $202 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $101 | $187 | $230 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $73 | $129 | $157 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $120 | $181 | $211 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $168 | $240 | $311 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $32 | $36 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $40 | $60 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $48 | $85 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $76 | $100 | $112 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $141 | $165 |
| Consultation office low complexity CPT 99243 • Office Visits | $5 | $133 | $187 |
| Consultation office high complexity CPT 99245 • Office Visits | $196 | $307 | $343 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $665 | $863 | $962 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $55 | $59 | $61 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,203 | $1,612 | $1,817 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $197 | $314 | $383 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,083 | $1,083 | $1,083 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $581 | $581 | $581 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $288 | $393 | $466 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $742 | $1,152 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $522 | $717 | $840 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $146 | $232 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $1,151 | $1,840 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $690 | $762 | $798 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $528 | $635 | $956 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $566 | $803 | $922 |
| Excision chalazion single CPT 67800 • Ophthalmology | $98 | $135 | $199 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $559 | $559 | $559 |