| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $140 | $140 | $140 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $81 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $124 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $126 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $24 | $24 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $61 | $61 | $61 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $72 | $115 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $131 | $132 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $297 | $332 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $363 | $363 | $363 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $65 | $88 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $81 | $81 |
| EMG needle each extremity complete CPT 95886 • Neurology | $94 | $94 | $94 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $40 | $42 | $45 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $56 | $87 | $118 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $79 | $107 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $181 | $186 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $110 | $198 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $72 | $73 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $73 | $73 | $73 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $123 | $141 | $159 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $167 | $184 | $201 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $49 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $40 | $50 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $53 | $76 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $141 | $141 | $141 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $64 | $99 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $133 | $133 | $133 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $196 | $197 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $38 | $38 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $50 | $70 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $100 | $100 | $101 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $50 | $71 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $100 | $104 |
| Consultation office low complexity CPT 99243 • Office Visits | $58 | $89 | $120 |
| Consultation office high complexity CPT 99245 • Office Visits | $18 | $118 | $218 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $598 | $598 | $598 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $37 | $45 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,147 | $1,147 | $1,147 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $240 | $240 | $240 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $545 | $1,061 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $485 | $488 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $229 | $229 | $229 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $727 | $727 | $727 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $261 | $395 | $530 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $64 | $98 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $114 | $638 | $1,161 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $266 | $502 |