| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $45 | $45 | $45 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $73 | $73 | $73 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $75 | $75 | $75 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $20 | $20 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $100 | $100 | $100 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $97 | $112 | $127 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $79 | $79 | $79 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $260 | $260 | $260 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $42 | $42 | $42 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $38 | $70 | $103 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $60 | $102 | $144 |
| EMG needle each extremity complete CPT 95886 • Neurology | $33 | $33 | $33 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $68 | $68 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $87 | $95 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $46 | $46 | $46 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $137 | $137 | $137 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $136 | $136 | $136 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $36 | $49 | $62 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $77 | $77 | $77 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $92 | $118 | $143 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $148 | $162 | $177 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $16 | $16 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $18 | $34 | $49 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $37 | $57 | $78 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $77 | $94 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $104 | $104 | $104 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $73 | $73 | $73 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $98 | $98 | $98 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $144 | $148 | $152 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $28 | $28 | $28 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $52 | $52 | $52 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $74 | $74 | $74 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $52 | $52 | $52 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $76 | $89 | $101 |
| Consultation office low complexity CPT 99243 • Office Visits | $88 | $98 | $108 |
| Consultation office high complexity CPT 99245 • Office Visits | $138 | $169 | $201 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $393 | $393 | $393 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $26 | $26 | $26 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $845 | $845 | $845 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $177 | $177 | $177 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $782 | $782 | $782 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $359 | $415 | $472 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $169 | $169 | $169 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $536 | $536 | $536 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $390 | $602 | $814 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $72 | $121 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $856 | $856 | $856 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $357 | $357 | $357 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $218 | $364 | $510 |