| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $133 | $151 | $168 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $75 | $82 | $88 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $99 | $100 | $100 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $104 | $133 | $162 |
| Group psychotherapy CPT 90853 • Mental Health | $48 | $50 | $52 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $2 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $61 | $61 | $61 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $14 | $65 | $117 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $63 | $63 | $63 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $297 | $297 | $297 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $348 | $348 | $348 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $105 | $105 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $66 | $109 | $152 |
| EMG needle each extremity complete CPT 95886 • Neurology | $18 | $18 | $18 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $84 | $84 | $84 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $44 | $44 | $44 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $72 | $99 | $126 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $28 | $28 | $28 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $112 | $112 | $112 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $70 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $7 | $24 | $42 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $152 | $177 | $202 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $169 | $179 | $189 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $26 | $42 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $24 | $33 | $42 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $11 | $27 | $42 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $88 | $103 | $118 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $15 | $28 | $42 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $40 | $41 | $42 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $42 | $76 | $111 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $42 | $102 | $163 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $42 | $42 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $29 | $35 | $42 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $42 | $77 | $112 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $6 | $24 | $42 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $9 | $9 | $9 |
| Consultation office low complexity CPT 99243 • Office Visits | $6 | $6 | $6 |
| Consultation office high complexity CPT 99245 • Office Visits | $147 | $147 | $147 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $276 | $276 | $276 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $4 | $4 | $4 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $881 | $1,075 | $1,269 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $50 | $135 | $221 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $826 | $826 | $826 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $55 | $55 | $55 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $255 | $255 | $255 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $42 | $423 | $803 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $54 | $54 | $54 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $10 | $10 | $10 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $128 | $128 | $128 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $259 | $259 | $259 |