| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $163 | $163 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $59 | $66 | $73 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $99 | $116 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $92 | $125 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $45 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $8 | $8 | $8 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $17 | $30 | $44 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $26 | $26 | $26 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $53 | $53 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $67 | $67 | $67 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $170 | $170 | $170 |
| EMG needle each extremity complete CPT 95886 • Neurology | $59 | $59 | $59 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $41 | $41 | $41 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $51 | $51 | $51 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $140 | $140 | $140 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $92 | $92 | $92 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $112 | $112 | $112 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $58 | $58 | $58 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $10 | $10 | $10 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $136 | $136 | $136 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $146 | $184 | $223 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $10 | $10 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $44 | $44 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $59 | $59 | $59 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $79 | $119 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $119 | $119 | $119 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $123 | $123 | $123 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $54 | $54 | $54 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $185 | $185 | $185 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $31 | $31 | $31 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $57 | $57 | $57 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $8 | $8 | $8 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $72 | $72 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $84 | $84 | $84 |
| Consultation office low complexity CPT 99243 • Office Visits | $61 | $61 | $61 |
| Consultation office high complexity CPT 99245 • Office Visits | $14 | $14 | $14 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $567 | $567 | $567 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $7 | $7 | $7 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,000 | $1,000 | $1,000 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $228 | $228 | $228 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $267 | $267 | $267 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $621 | $621 | $621 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $58 | $58 | $58 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $44 | $44 | $44 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $662 | $662 | $662 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $44 | $44 | $44 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,441 | $1,441 | $1,441 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $127 | $127 | $127 |