| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $146 | $155 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $59 | $63 | $67 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $94 | $110 | $127 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $120 | $142 |
| Group psychotherapy CPT 90853 • Mental Health | $55 | $57 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $1 | $1 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $93 | $93 | $93 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $23 | $23 | $23 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $134 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $73 | $212 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $86 | $86 | $86 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $22 | $22 | $22 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $97 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $20 | $20 | $20 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $21 | $41 | $60 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $105 | $105 | $105 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $57 | $57 | $57 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $58 | $74 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $12 | $71 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $24 | $95 | $166 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $90 | $90 | $90 |
| Office visit established patient minimal CPT 99211 • Office Visits | $3 | $3 | $3 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $5 | $28 | $51 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $10 | $54 | $99 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $42 | $101 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $71 | $118 | $164 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $145 | $145 | $145 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $13 | $13 | $13 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $16 | $16 | $16 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $69 | $69 | $69 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $110 | $110 | $110 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $130 | $130 | $130 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $10 | $10 | $10 |
| Consultation office low complexity CPT 99243 • Office Visits | $46 | $81 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $213 | $213 | $213 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $60 | $60 | $60 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $4 | $4 | $4 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $792 | $961 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $99 | $99 | $99 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $733 | $733 | $733 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $72 | $72 | $72 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $29 | $29 | $30 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $107 | $107 | $107 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $365 | $365 | $365 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $11 | $11 | $11 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,142 | $1,142 | $1,142 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $99 | $99 | $99 |