| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $141 | $141 | $141 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $62 | $63 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $107 | $133 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $75 | $87 | $100 |
| Group psychotherapy CPT 90853 • Mental Health | $33 | $37 | $42 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $3 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $86 | $86 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $79 | $89 | $98 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $86 | $86 | $86 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $336 | $336 | $336 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $58 | $58 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $58 | $58 | $58 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $83 | $125 | $166 |
| EMG needle each extremity complete CPT 95886 • Neurology | $146 | $146 | $146 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $39 | $39 | $39 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $58 | $58 | $58 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $75 | $107 | $139 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $261 | $261 | $261 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $38 | $38 | $38 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $96 | $96 | $96 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $94 | $143 | $193 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $34 | $49 | $63 |
| Office visit established patient minimal CPT 99211 • Office Visits | $4 | $20 | $37 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $2 | $2 | $2 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $77 | $77 | $77 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $89 | $89 | $89 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $100 | $100 | $100 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $116 | $116 | $116 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $140 | $140 | $140 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $104 | $104 | $104 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $34 | $34 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $89 | $89 | $89 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $129 | $129 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $91 | $91 | $91 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $68 | $68 | $68 |
| Consultation office low complexity CPT 99243 • Office Visits | $86 | $90 | $94 |
| Consultation office high complexity CPT 99245 • Office Visits | $27 | $27 | $27 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $281 | $281 | $281 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $30 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $846 | $1,027 | $1,208 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $38 | $38 | $38 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $112 | $112 | $112 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $518 | $518 | $518 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $62 | $184 | $307 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $382 | $382 | $382 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $557 | $557 | $557 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $88 | $88 | $88 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $34 | $625 | $1,216 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $102 | $102 | $102 |