| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $79 | $79 | $79 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $115 | $115 | $115 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $120 | $120 | $120 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $31 | $31 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $8 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $105 | $186 | $266 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $158 | $192 | $225 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $240 | $247 | $254 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $397 | $397 | $397 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $404 | $404 | $404 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $113 | $123 | $132 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $96 | $129 | $162 |
| EMG needle each extremity complete CPT 95886 • Neurology | $55 | $55 | $55 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $67 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $77 | $137 | $198 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $101 | $170 | $238 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $212 | $262 | $311 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $338 | $424 | $509 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $56 | $98 | $128 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $102 | $129 | $157 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $188 | $285 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $190 | $314 | $391 |
| Office visit established patient minimal CPT 99211 • Office Visits | $40 | $40 | $41 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $34 | $56 | $78 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $67 | $119 | $161 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $141 | $186 | $227 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $125 | $161 | $196 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $135 | $154 | $179 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $182 | $212 | $242 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $193 | $259 | $355 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $44 | $50 | $57 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $96 | $122 | $142 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $118 | $171 | $213 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $97 | $112 | $128 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $137 | $188 |
| Consultation office low complexity CPT 99243 • Office Visits | $171 | $193 | $215 |
| Consultation office high complexity CPT 99245 • Office Visits | $230 | $312 | $394 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,963 | $1,963 | $1,963 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $221 | $221 | $221 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,274 | $2,274 | $2,274 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $789 | $789 | $789 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $3,533 | $3,533 | $3,533 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $626 | $1,351 | $2,077 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $957 | $957 | $957 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,440 | $1,440 | $1,440 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $2,065 | $2,065 | $2,065 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $194 | $194 | $194 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,872 | $3,872 | $3,872 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,673 | $1,673 | $1,673 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $423 | $505 | $588 |