| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $168 | $184 | $200 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $88 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $97 | $106 | $116 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $137 | $149 | $162 |
| Group psychotherapy CPT 90853 • Mental Health | $37 | $43 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $1 | $1 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $16 | $16 | $16 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $14 | $14 | $14 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $16 | $16 | $16 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $186 | $186 | $186 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $425 | $425 | $425 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $50 | $50 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $174 | $174 | $174 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $46 | $46 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $30 | $30 | $30 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $196 | $196 | $196 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $292 | $292 | $292 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $75 | $84 | $94 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $11 | $72 | $133 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $198 | $202 | $206 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $187 | $245 | $304 |
| Office visit established patient minimal CPT 99211 • Office Visits | $3 | $23 | $42 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $12 | $34 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $11 | $62 | $113 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $11 | $86 | $161 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $143 | $161 | $178 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $124 | $124 | $124 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $148 | $148 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $98 | $98 | $98 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $19 | $19 | $19 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $79 | $97 | $116 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $113 | $113 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $90 | $90 | $90 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $16 | $16 | $16 |
| Consultation office low complexity CPT 99243 • Office Visits | $12 | $12 | $12 |
| Consultation office high complexity CPT 99245 • Office Visits | $22 | $22 | $22 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $291 | $291 | $291 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $69 | $69 | $69 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $885 | $885 | $885 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $341 | $341 | $341 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $121 | $121 | $121 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $646 | $646 | $646 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $30 | $30 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $595 | $595 | $595 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $448 | $448 | $448 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $51 | $51 | $51 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $798 | $798 | $798 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $251 | $251 | $251 |