| Group psychotherapy CPT 90853 • Mental Health | $39 | $46 | $52 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $407 | $407 | $407 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $133 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $310 | $310 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $35 | $100 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $58 | $157 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $134 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $90 | $90 | $90 |
| Office visit established patient minimal CPT 99211 • Office Visits | $41 | $46 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $81 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $35 | $121 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $62 | $62 | $62 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $75 | $244 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $64 | $146 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $81 | $194 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $66 | $258 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $49 | $69 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $110 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $91 | $162 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $109 | $136 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $174 | $238 |
| Consultation office straightforward CPT 99241 • Office Visits | $25 | $25 | $25 |
| Consultation office low complexity CPT 99243 • Office Visits | $92 | $104 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $146 | $322 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $601 | $601 | $601 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $37 | $37 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,047 | $1,047 | $1,047 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $482 | $482 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $88 | $88 | $88 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,141 | $1,141 | $1,141 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $495 | $495 | $495 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $326 | $326 | $326 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $83 | $83 | $83 |
| Visual field examination CPT 92083 • Ophthalmology | $60 | $60 | $60 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $24 | $24 | $24 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $48 | $48 | $48 |
| Arthrocentesis aspiration intermediate joint CPT 20605 • Orthopedics | $91 | $91 | $91 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $5,459 | $5,459 | $5,459 |
| Lumbar spine fusion posterior approach CPT 22612 • Orthopedics | $5,100 | $5,100 | $5,100 |
| Lumbar spine fusion combined approach CPT 22633 • Orthopedics | $1,800 | $1,800 | $1,800 |