| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $109 | $131 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $74 | $85 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $105 | $116 | $128 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $113 | $131 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $46 | $59 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $2 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $62 | $62 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $66 | $66 | $66 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $12 | $12 | $12 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $311 | $311 | $311 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $103 | $175 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $74 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $35 | $62 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $56 | $67 | $78 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $35 | $105 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $101 | $101 | $101 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $67 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $96 | $104 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $104 | $123 | $133 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $161 | $172 | $180 |
| Office visit established patient minimal CPT 99211 • Office Visits | $4 | $16 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $48 | $51 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $72 | $83 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $19 | $96 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $150 | $160 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $49 | $100 | $152 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $54 | $103 | $152 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $168 | $190 | $212 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $4 | $59 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $115 | $115 | $116 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $15 | $65 | $115 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $73 | $115 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $116 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $46 | $81 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $92 | $182 | $272 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $266 | $266 | $266 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $5 | $5 | $5 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,131 |
| 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 | $42 | $42 | $42 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $143 | $429 | $715 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $30 | $30 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $16 | $63 | $109 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,141 | $1,141 | $1,142 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $477 | $477 | $477 |