| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $101 | $132 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $76 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $84 | $113 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $135 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $50 | $59 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $359 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $118 | $124 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $167 | $174 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $71 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $118 | $125 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $106 | $134 |
| 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 | $59 | $73 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $110 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $122 | $148 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $161 | $195 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $52 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $75 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $104 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $159 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $83 | $152 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $122 | $152 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $129 | $192 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $78 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $73 | $115 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $80 | $115 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $70 | $115 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $132 | $156 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $61 | $92 |
| Consultation office high complexity CPT 99245 • Office Visits | $202 | $267 | $326 |
| 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 | $30 | $539 | $1,047 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $482 | $483 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $715 | $715 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $276 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $30 | $30 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $263 | $495 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $326 | $662 | $998 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |
| Excision chalazion single CPT 67800 • Ophthalmology | $15 | $15 | $15 |