| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $147 | $162 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $78 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $84 | $120 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $155 | $162 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $53 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $158 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $380 | $380 | $380 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $113 | $113 | $113 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $162 | $162 | $162 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $90 | $91 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $113 | $113 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $135 | $136 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $177 | $178 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $291 | $291 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $85 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $107 | $120 | $133 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $133 | $152 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $168 | $177 | $183 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $57 | $59 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $72 | $98 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $80 | $106 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $154 | $175 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $89 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $112 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $140 | $179 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $88 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $74 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $91 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $79 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $117 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $103 | $170 |
| Consultation office high complexity CPT 99245 • Office Visits | $202 | $237 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $30 | $30 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $30 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $237 | $237 | $237 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $626 | $626 | $626 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $715 | $715 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $30 | $30 |
| 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 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $226 | $423 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $462 | $462 |