| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $200 | $200 | $200 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $89 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $132 | $143 | $154 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $121 | $140 | $160 |
| Group psychotherapy CPT 90853 • Mental Health | $42 | $46 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $1 | $1 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $40 | $107 | $173 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $61 | $61 | $61 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $126 | $127 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $55 | $214 | $372 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $55 | $240 | $425 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $87 | $124 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $95 | $134 | $174 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $48 | $72 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $93 | $124 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $70 | $72 | $74 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $103 | $150 | $196 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $180 | $236 | $292 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $5 | $59 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $74 | $117 | $160 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $19 | $100 | $181 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $81 | $142 | $202 |
| Office visit established patient minimal CPT 99211 • Office Visits | $33 | $33 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $7 | $37 | $67 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $24 | $67 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $38 | $99 | $161 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $72 | $143 | $214 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $124 | $135 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $33 | $115 | $197 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $20 | $155 | $291 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $57 | $70 | $84 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $89 | $97 | $105 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $107 | $129 | $150 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $71 | $89 | $106 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $155 | $155 | $156 |
| Consultation office low complexity CPT 99243 • Office Visits | $9 | $9 | $9 |
| Consultation office high complexity CPT 99245 • Office Visits | $245 | $285 | $326 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $93 | $280 | $467 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $8 | $38 | $69 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,180 | $1,180 | $1,180 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $256 | $256 | $256 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,206 | $1,206 | $1,207 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $452 | $549 | $645 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $166 | $201 | $236 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $159 | $159 | $159 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $33 | $33 | $33 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $75 | $75 | $75 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,198 | $1,198 | $1,198 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $521 | $521 | $522 |