| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $98 | $98 | $98 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $159 | $159 | $159 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $164 | $164 | $164 |
| 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 | $213 | $213 | $213 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $121 | $163 | $206 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $206 | $206 | $206 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $544 | $544 | $544 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $645 | $645 | $645 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $100 | $103 | $106 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $154 | $207 | $261 |
| EMG needle each extremity complete CPT 95886 • Neurology | $72 | $72 | $72 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $84 | $84 | $84 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $64 | $72 | $80 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $221 | $221 | $221 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $169 | $169 | $169 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $168 | $168 | $168 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $116 | $116 | $116 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $117 | $117 | $117 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $181 | $216 | $252 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $50 | $184 | $318 |
| Office visit established patient minimal CPT 99211 • Office Visits | $35 | $35 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $69 | $69 | $69 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $80 | $80 | $80 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $119 | $121 | $122 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $173 | $173 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $158 | $158 | $158 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $213 | $213 | $213 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $208 | $261 | $313 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $61 | $61 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $112 | $112 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $161 | $161 | $161 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $113 | $113 | $113 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $137 | $165 |
| Consultation office low complexity CPT 99243 • Office Visits | $126 | $158 | $190 |
| Consultation office high complexity CPT 99245 • Office Visits | $226 | $287 | $348 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $839 | $839 | $839 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $70 | $70 | $70 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,814 | $1,814 | $1,814 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $319 | $319 | $319 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,672 | $1,672 | $1,672 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $495 | $631 | $766 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $456 | $456 | $456 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,148 | $1,148 | $1,148 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $836 | $836 | $836 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $151 | $151 | $151 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,837 | $1,837 | $1,837 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $763 | $763 | $763 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $338 | $430 | $523 |