| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $120 | $132 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $79 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $126 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $76 | $113 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $55 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $45 | $61 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $80 | $80 | $80 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $20 | $20 | $20 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $367 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $86 | $232 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $50 | $50 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $81 | $120 | $160 |
| EMG needle each extremity complete CPT 95886 • Neurology | $49 | $73 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $63 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $27 | $27 | $27 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $35 | $105 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $35 | $59 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $81 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $124 | $143 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $27 | $109 | $191 |
| Office visit established patient minimal CPT 99211 • Office Visits | $3 | $17 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $8 | $42 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $13 | $62 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $62 | $80 | $103 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $21 | $107 | $168 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $10 | $81 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $66 | $106 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $128 | $179 | $212 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $100 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $10 | $67 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $10 | $81 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $105 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $15 | $96 | $143 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $143 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $138 | $254 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $363 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $26 | $28 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $848 | $1,084 | $1,319 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $138 | $192 | $245 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $539 | $1,048 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $48 | $48 | $48 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $124 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $72 | $367 | $663 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $261 | $379 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $55 | $87 | $119 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,141 | $1,141 | $1,142 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $200 | $541 |