| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $148 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $136 | $164 | $191 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $51 | $51 | $51 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $71 | $71 | $71 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $94 | $94 | $94 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $113 | $113 | $113 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $91 | $91 | $91 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $96 | $96 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $76 | $76 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $21 | $21 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $147 | $147 | $147 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $85 | $85 | $85 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $407 | $407 | $407 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $64 | $64 | $64 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $33 | $33 | $33 |
| EMG needle each extremity complete CPT 95886 • Neurology | $86 | $86 | $86 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $23 | $68 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $73 | $73 | $73 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $262 | $262 | $262 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $71 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $170 | $170 | $170 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $142 | $185 | $228 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $233 | $286 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $18 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $48 | $48 | $48 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $149 | $149 | $149 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $104 | $123 | $142 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $275 | $275 | $275 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $168 | $168 | $168 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $196 | $222 | $248 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $75 | $75 | $75 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $68 | $68 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $103 | $103 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $117 | $117 | $117 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $139 | $174 |
| Consultation office low complexity CPT 99243 • Office Visits | $106 | $106 | $106 |
| Consultation office high complexity CPT 99245 • Office Visits | $201 | $201 | $201 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $610 | $610 | $610 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $496 | $496 | $496 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $155 | $155 | $155 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $492 | $492 | $492 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $324 | $370 | $415 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $969 | $969 | $969 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $115 | $115 | $115 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $26 | $26 | $26 |
| Fundus photography CPT 92250 • Ophthalmology | $35 | $35 | $35 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $73 | $77 | $80 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $2,140 | $2,140 | $2,140 |