| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $200 | $200 | $200 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $84 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $131 | $131 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $160 | $160 | $161 |
| Group psychotherapy CPT 90853 • Mental Health | $37 | $43 | $50 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $33 | $103 | $173 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $12 | $12 | $12 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $89 | $107 | $126 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $317 | $345 | $372 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $213 | $319 | $425 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $25 | $74 | $124 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $95 | $134 | $174 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $68 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $71 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $25 | $74 | $124 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $148 | $148 | $148 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $196 | $196 | $196 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $112 | $202 | $292 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $37 | $75 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $160 | $160 | $161 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $12 | $12 | $12 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $228 | $265 | $303 |
| Office visit established patient minimal CPT 99211 • Office Visits | $26 | $30 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $22 | $45 | $67 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $11 | $60 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $33 | $97 | $161 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $16 | $115 | $214 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $131 | $139 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $160 | $179 | $197 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $29 | $160 | $291 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $19 | $51 | $84 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $35 | $70 | $105 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $143 | $146 | $150 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $80 | $93 | $106 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $52 | $104 | $155 |
| Consultation office low complexity CPT 99243 • Office Visits | $32 | $63 | $94 |
| Consultation office high complexity CPT 99245 • Office Visits | $277 | $302 | $326 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $47 | $257 | $467 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $26 | $48 | $69 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,180 | $1,180 | $1,180 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $32 | $32 | $33 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $241 | $724 | $1,206 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $65 | $355 | $645 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $301 | $301 | $301 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $79 | $79 | $79 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $33 | $33 | $33 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $51 | $51 | $51 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $240 | $240 | $240 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $377 | $449 | $521 |