| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $107 | $135 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $91 | $100 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $97 | $105 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $24 | $26 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $4 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $144 | $164 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $33 | $56 | $79 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $135 | $135 | $136 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $50 | $151 | $252 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $271 | $271 | $271 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $72 | $90 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $85 | $108 | $131 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $55 | $80 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $97 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $102 | $152 | $203 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $197 | $265 | $333 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $70 | $97 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $9 | $81 | $150 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $50 | $139 | $228 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $111 | $207 | $304 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $11 | $16 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $3 | $23 | $34 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $5 | $60 | $123 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $7 | $64 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $11 | $91 | $164 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $8 | $43 | $78 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $54 | $80 | $107 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $79 | $173 | $282 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $5 | $18 | $32 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $58 | $58 | $59 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $71 | $106 | $163 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $6 | $63 | $126 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $9 | $84 | $158 |
| Consultation office low complexity CPT 99243 • Office Visits | $86 | $90 | $95 |
| Consultation office high complexity CPT 99245 • Office Visits | $25 | $114 | $203 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $351 | $426 | $501 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $13 | $39 | $65 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $763 | $926 | $1,089 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $138 | $228 | $317 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $34 | $562 | $1,091 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $582 | $582 | $583 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $209 | $209 | $209 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $490 | $490 | $490 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $106 | $106 | $106 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $100 | $150 | $200 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,112 | $1,112 | $1,112 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $96 | $357 | $617 |