| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $481 | $481 | $481 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $96 | $155 | $214 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $208 | $295 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $226 | $341 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $63 | $82 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $9 | $11 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $271 | $316 | $362 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $245 | $372 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $130 | $272 | $371 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $100 | $597 | $1,258 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $100 | $622 | $1,144 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $124 | $147 | $169 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $142 | $188 | $244 |
| EMG needle each extremity complete CPT 95886 • Neurology | $154 | $155 | $156 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $99 | $199 | $299 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $117 | $126 | $138 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $149 | $194 | $250 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $186 | $303 | $528 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $317 | $326 | $335 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $118 | $158 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $183 | $218 | $254 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $269 | $365 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $304 | $385 | $499 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $36 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $80 | $112 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $112 | $182 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $156 | $254 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $247 | $302 | $357 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $129 | $183 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $236 | $261 | $287 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $292 | $341 | $383 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $67 | $88 | $109 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $110 | $175 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $161 | $272 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $111 | $178 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $156 | $197 | $252 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $117 | $203 |
| Consultation office high complexity CPT 99245 • Office Visits | $326 | $405 | $484 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,543 | $1,641 | $1,738 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $117 | $117 | $117 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,022 | $2,783 | $3,544 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $573 | $656 | $740 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $1,213 | $3,281 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $541 | $1,105 | $1,669 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $750 | $825 | $899 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,356 | $1,797 | $2,238 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $918 | $1,634 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $182 | $342 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $2,113 | $3,569 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $790 | $1,550 |