| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $154 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $76 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $128 | $139 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $113 | $131 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $58 | $68 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $12 | $21 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $13 | $13 | $13 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $94 | $94 | $94 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $183 | $183 | $183 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $215 | $215 | $215 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $97 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $71 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $67 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $22 | $22 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $27 | $41 | $55 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $123 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $143 | $143 | $143 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $11 | $40 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $55 | $82 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $96 | $162 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $18 | $116 | $215 |
| Office visit established patient minimal CPT 99211 • Office Visits | $4 | $17 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $50 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $7 | $47 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $115 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $141 | $150 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $10 | $90 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $20 | $75 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $114 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $129 | $129 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $97 | $113 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $15 | $72 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $80 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $15 | $72 | $129 |
| Consultation office low complexity CPT 99243 • Office Visits | $171 | $171 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $142 | $254 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $42 | $53 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $8 | $19 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $848 | $989 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $99 | $148 | $197 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $277 | $524 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $362 | $362 | $362 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $227 | $227 | $227 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $715 | $715 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $261 | $261 | $261 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $37 | $44 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,142 | $1,142 | $1,142 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $182 | $334 |