| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $209 | $209 | $209 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $306 | $306 | $306 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $319 | $319 | $319 |
| Group psychotherapy CPT 90853 • Mental Health | $83 | $83 | $83 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $14 | $14 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $168 | $400 | $516 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $352 | $467 | $524 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $349 | $349 | $349 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $630 | $713 | $879 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $590 | $809 | $1,248 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $158 | $239 | $280 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $250 | $294 | $369 |
| EMG needle each extremity complete CPT 95886 • Neurology | $146 | $146 | $146 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $163 | $163 | $163 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $204 | $204 | $204 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $185 | $185 | $185 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $237 | $237 | $237 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $572 | $572 | $572 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $176 | $185 | $190 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $72 | $201 | $281 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $305 | $388 | $430 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $484 | $521 | $540 |
| Office visit established patient minimal CPT 99211 • Office Visits | $53 | $58 | $61 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $92 | $112 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $55 | $74 | $121 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $66 | $170 | $277 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $263 | $338 | $376 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $240 | $256 | $265 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $324 | $355 | $371 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $477 | $520 | $542 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $93 | $105 | $111 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $95 | $155 | $199 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $246 | $271 | $284 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $171 | $193 | $203 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $252 | $280 | $294 |
| Consultation office low complexity CPT 99243 • Office Visits | $288 | $317 | $374 |
| Consultation office high complexity CPT 99245 • Office Visits | $455 | $608 | $685 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,621 | $1,852 | $1,968 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $98 | $167 | $201 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,131 | $3,131 | $3,131 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $651 | $877 | $990 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,888 | $3,151 | $3,283 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,324 | $1,602 | $1,742 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $623 | $1,008 | $1,272 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,983 | $2,675 | $3,021 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,445 | $1,921 | $2,159 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $268 | $461 | $629 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,172 | $4,069 | $4,517 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,318 | $1,739 | $1,949 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $903 | $2,340 | $3,059 |