| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $115 | $139 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $50 | $61 | $72 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $77 | $79 | $82 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $80 | $97 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $21 | $21 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $1 | $1 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $164 | $164 | $164 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $14 | $14 | $14 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $118 | $127 | $135 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $252 | $252 | $252 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $57 | $164 | $271 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $18 | $54 | $90 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $131 | $151 | $171 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $95 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $96 | $100 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $129 | $129 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $83 | $112 | $142 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $82 | $143 | $203 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $167 | $250 | $333 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $19 | $38 | $57 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $63 | $73 | $83 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $10 | $53 | $96 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $130 | $145 | $160 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $17 | $18 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $32 | $34 | $37 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $45 | $49 | $53 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $64 | $81 | $99 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $21 | $59 | $98 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $67 | $72 | $78 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $11 | $59 | $107 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $134 | $146 | $158 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $21 | $27 | $32 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $40 | $49 | $58 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $65 | $74 | $83 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $27 | $43 | $58 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $82 | $85 |
| Consultation office low complexity CPT 99243 • Office Visits | $91 | $102 | $113 |
| Consultation office high complexity CPT 99245 • Office Visits | $203 | $203 | $203 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $501 | $502 | $503 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $65 | $65 | $66 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $772 | $772 | $772 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $29 | $29 | $29 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $115 | $603 | $1,091 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $90 | $336 | $582 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $228 | $228 | $228 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $147 | $147 | $147 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $124 | $124 | $124 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $48 | $48 | $48 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $308 | $308 | $308 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $241 | $429 | $617 |