| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $97 | $97 | $97 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $157 | $157 | $157 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $163 | $163 | $163 |
| Group psychotherapy CPT 90853 • Mental Health | $43 | $43 | $43 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $212 | $364 | $516 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $116 | $243 | $410 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $200 | $200 | $200 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $461 | $545 | $630 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $90 | $340 | $590 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $81 | $157 | $280 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $129 | $148 | $157 |
| EMG needle each extremity complete CPT 95886 • Neurology | $148 | $148 | $148 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $146 | $146 | $146 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $109 | $147 | $186 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $222 | $222 | $222 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $292 | $292 | $292 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $465 | $465 | $465 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $115 | $152 | $190 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $116 | $198 | $281 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $107 | $245 | $430 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $345 | $540 |
| Office visit established patient minimal CPT 99211 • Office Visits | $35 | $48 | $61 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $69 | $90 | $112 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $79 | $131 | $183 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $110 | $129 | $165 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $171 | $273 | $376 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $156 | $210 | $265 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $211 | $291 | $371 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $16 | $289 | $542 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $60 | $86 | $111 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $111 | $155 | $199 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $160 | $222 | $284 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $112 | $158 | $203 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $110 | $189 | $294 |
| Consultation office low complexity CPT 99243 • Office Visits | $118 | $214 | $374 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $334 | $685 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $938 | $1,453 | $1,968 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $70 | $136 | $201 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,807 | $1,807 | $1,807 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $317 | $584 | $851 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,669 | $2,476 | $3,283 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $997 | $1,742 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $360 | $816 | $1,272 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,145 | $2,083 | $3,021 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $834 | $1,497 | $2,159 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $154 | $320 | $486 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,830 | $3,174 | $4,517 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $762 | $1,355 | $1,949 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $326 | $1,284 | $3,059 |