| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $160 | $160 | $160 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $70 | $73 | $77 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $113 | $131 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $117 | $134 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $19 | $19 | $19 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $50 | $50 | $50 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $81 | $132 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $142 | $151 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $368 | $370 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $437 | $437 | $437 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $41 | $41 | $41 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $90 | $126 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $36 | $36 | $36 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $41 | $43 | $45 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $82 | $82 | $82 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $98 | $116 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $65 | $120 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $302 | $319 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $40 | $55 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $92 | $92 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $168 | $172 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $148 | $148 | $148 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $20 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $36 | $45 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $49 | $68 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $53 | $76 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $80 | $80 | $80 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $55 | $80 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $108 | $108 | $108 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $159 | $164 | $168 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $28 | $28 | $28 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $56 | $81 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $76 | $122 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $44 | $57 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $111 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $73 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $139 | $197 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $522 | $522 | $522 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $29 | $29 | $29 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,344 | $1,344 | $1,344 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $208 | $208 | $208 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $476 | $923 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $395 | $439 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $331 | $331 | $331 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $826 | $826 | $826 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $324 | $619 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $71 | $112 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $486 | $941 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $219 | $407 |