| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $123 | $145 | $167 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $76 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $95 | $103 | $112 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $128 | $130 | $132 |
| Group psychotherapy CPT 90853 • Mental Health | $20 | $32 | $44 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $42 | $113 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $99 | $99 | $99 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $89 | $120 | $152 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $183 | $253 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $368 | $369 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $79 | $107 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $37 | $98 | $160 |
| EMG needle each extremity complete CPT 95886 • Neurology | $20 | $49 | $79 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $94 | $105 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $116 | $129 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $61 | $67 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $34 | $101 | $168 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $141 | $200 | $259 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $76 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $55 | $92 | $130 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $13 | $28 | $42 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $42 | $129 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $15 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $49 | $52 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $37 | $63 | $90 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $103 | $104 | $106 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $22 | $98 | $174 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $79 | $113 | $148 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $54 | $109 | $164 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $149 | $194 | $239 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $110 | $113 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $115 | $115 | $116 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $84 | $103 | $123 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $115 | $115 | $116 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $13 | $69 | $126 |
| Consultation office low complexity CPT 99243 • Office Visits | $42 | $66 | $91 |
| Consultation office high complexity CPT 99245 • Office Visits | $203 | $236 | $269 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $372 | $442 | $512 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $7 | $44 | $81 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,089 | $1,089 | $1,089 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $178 | $178 | $178 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,048 | $1,101 | $1,155 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $623 | $763 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $193 | $193 | $193 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $109 | $188 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $30 | $30 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $118 | $118 | $118 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $38 | $38 | $38 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $86 | $351 | $615 |