| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $133 | $155 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $75 | $82 | $89 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $127 | $127 | $128 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $150 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $66 | $72 | $78 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $0 | $0 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $93 | $93 | $93 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $15 | $15 | $15 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $18 | $18 | $18 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $367 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $430 | $430 | $430 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $88 | $88 | $88 |
| 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 | $60 | $64 | $67 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $105 | $105 | $105 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $112 | $112 | $112 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $60 | $60 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $12 | $12 | $12 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $96 | $162 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $162 | $170 | $179 |
| Office visit established patient minimal CPT 99211 • Office Visits | $4 | $4 | $4 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $43 | $43 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $7 | $7 | $7 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $115 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $151 | $151 | $151 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $97 | $97 | $97 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $30 | $30 | $30 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $24 | $24 | $24 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $3 | $3 | $3 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $80 | $80 | $80 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $97 | $97 | $97 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $70 | $70 | $70 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $87 | $87 | $87 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $55 | $79 |
| Consultation office high complexity CPT 99245 • Office Visits | $119 | $119 | $119 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $266 | $266 | $266 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $30 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $886 | $1,008 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $30 | $104 | $178 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $210 | $210 | $210 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $362 | $362 | $362 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $46 | $136 | $226 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $561 | $561 | $561 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $521 | $521 | $522 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $55 | $55 | $55 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $856 | $856 | $856 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |