| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $126 | $126 | $126 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $78 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $116 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $85 | $118 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $19 | $19 | $19 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $212 | $212 | $212 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $106 | $182 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $161 | $189 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $46 | $206 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $363 | $363 | $363 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $100 | $105 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $66 | $113 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $37 | $37 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $35 | $62 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $54 | $83 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $99 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $121 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $247 | $266 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $52 | $62 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $49 | $49 | $49 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $124 | $144 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $111 | $178 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $48 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $48 | $66 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $62 | $94 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $86 | $86 | $86 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $41 | $52 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $80 | $80 | $80 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $107 | $153 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $39 | $48 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $51 | $73 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $41 | $51 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $73 | $101 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $54 | $78 |
| Consultation office high complexity CPT 99245 • Office Visits | $144 | $199 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $378 | $378 | $378 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $34 | $34 | $34 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $886 | $886 | $886 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $153 | $153 | $153 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $436 | $842 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $402 | $442 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $271 | $271 | $271 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $564 | $564 | $564 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $222 | $413 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $66 | $103 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $458 | $885 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $248 | $466 |