| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $98 | $98 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $108 | $108 | $108 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $30 | $30 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $80 | $80 | $80 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $132 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $117 | $117 | $117 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $55 | $55 | $55 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $396 | $396 | $396 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $37 | $37 | $37 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $85 | $85 | $85 |
| EMG needle each extremity complete CPT 95886 • Neurology | $51 | $51 | $51 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $48 | $48 | $48 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $58 | $58 | $58 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $105 | $105 | $105 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $45 | $59 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $81 | $88 | $95 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $135 | $140 | $146 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $183 | $183 | $183 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $9 | $9 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $23 | $24 | $25 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $45 | $49 | $52 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $92 | $93 | $95 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $100 | $100 | $100 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $91 | $91 | $91 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $125 | $125 | $125 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $184 | $184 | $184 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $38 | $38 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $68 | $68 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $97 | $97 | $97 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $69 | $69 | $69 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $99 | $99 | $99 |
| Consultation office low complexity CPT 99243 • Office Visits | $128 | $128 | $128 |
| Consultation office high complexity CPT 99245 • Office Visits | $232 | $232 | $232 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $575 | $575 | $575 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $48 | $48 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,021 | $1,021 | $1,021 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $291 | $291 | $291 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $986 | $986 | $986 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $524 | $524 | $524 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $340 | $340 | $340 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $902 | $902 | $902 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $642 | $642 | $642 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $185 | $185 | $185 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,348 | $1,348 | $1,348 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $560 | $560 | $560 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $859 | $859 | $859 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $498 | $498 | $498 |