| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $167 | $167 | $168 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $70 | $80 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $99 | $116 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $132 | $132 | $132 |
| Group psychotherapy CPT 90853 • Mental Health | $50 | $58 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $2 | $2 | $2 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $18 | $101 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $42 | $56 | $69 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $76 | $114 | $152 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $274 | $298 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $50 | $210 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $44 | $76 | $107 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $72 | $111 | $151 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $60 | $79 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $42 | $62 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $46 | $75 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $63 | $63 | $63 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $84 | $126 | $168 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $97 | $178 | $259 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $92 | $92 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $57 | $94 | $130 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $12 | $27 | $42 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $42 | $146 | $250 |
| Office visit established patient minimal CPT 99211 • Office Visits | $24 | $26 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $19 | $37 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $29 | $59 | $90 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $42 | $68 | $94 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $174 | $174 | $175 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $148 | $148 | $149 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $51 | $108 | $164 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $15 | $127 | $239 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $87 | $101 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $54 | $84 | $115 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $42 | $83 | $123 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $5 | $60 | $115 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $108 | $117 | $126 |
| Consultation office low complexity CPT 99243 • Office Visits | $42 | $66 | $91 |
| Consultation office high complexity CPT 99245 • Office Visits | $140 | $204 | $269 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $77 | $294 | $512 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $13 | $47 | $81 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,053 | $1,053 | $1,053 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $57 | $57 | $57 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $173 | $664 | $1,155 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $76 | $420 | $763 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $354 | $354 | $354 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $42 | $42 | $42 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $42 | $78 | $114 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $60 | $89 | $118 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $42 | $562 | $1,082 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $119 | $367 | $615 |