| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $317 | $336 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $143 | $151 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $177 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $224 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $56 | $71 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $265 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $271 | $354 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $271 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $399 | $851 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $449 | $826 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $165 | $165 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $208 | $208 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $115 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $233 | $233 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $67 | $105 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $171 | $345 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $178 | $297 | $454 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $393 | $476 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $87 | $111 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $121 | $153 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $138 | $212 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $113 | $251 | $403 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $29 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $51 | $65 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $84 | $109 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $116 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $153 | $181 | $219 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $122 | $153 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $171 | $226 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $250 | $294 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $51 | $66 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $92 | $111 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $131 | $172 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $85 | $107 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $144 | $211 |
| Consultation office low complexity CPT 99243 • Office Visits | $170 | $176 | $194 |
| Consultation office high complexity CPT 99245 • Office Visits | $308 | $345 | $382 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,678 | $1,678 | $1,678 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $226 | $226 | $226 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,851 | $3,851 | $3,851 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $1,118 | $1,118 | $1,118 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $3,954 | $3,954 | $3,954 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $2,076 | $2,076 | $2,076 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $970 | $970 | $970 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $2,661 | $2,661 | $2,661 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $729 | $1,432 | $2,135 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $334 | $334 | $334 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $5,343 | $5,343 | $5,343 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,660 | $1,660 | $1,660 |