| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $159 | $159 | $159 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $83 | $97 | $111 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $122 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $92 | $128 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $26 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $97 | $114 | $130 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $134 | $247 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $108 | $175 | $215 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $100 | $251 | $440 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $48 | $61 | $73 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $30 | $157 | $284 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $94 | $108 |
| EMG needle each extremity complete CPT 95886 • Neurology | $83 | $100 | $116 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $70 | $94 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $86 | $101 | $110 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $74 | $143 | $254 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $127 | $174 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $176 | $354 | $509 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $43 | $56 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $80 | $84 | $87 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $136 | $205 | $342 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $54 | $160 | $255 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $15 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $48 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $55 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $88 | $119 | $136 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $95 | $137 | $180 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $80 | $126 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $116 | $130 | $145 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $171 | $218 | $252 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $38 | $42 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $61 | $91 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $89 | $108 | $125 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $61 | $91 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $89 | $107 | $133 |
| Consultation office low complexity CPT 99243 • Office Visits | $18 | $83 | $120 |
| Consultation office high complexity CPT 99245 • Office Visits | $32 | $161 | $278 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $523 | $523 | $523 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $55 | $108 | $160 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $937 | $1,206 | $1,474 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $272 | $272 | $272 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $490 | $949 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $72 | $286 | $500 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $359 | $364 | $369 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $860 | $924 | $988 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $618 | $836 | $1,096 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $130 | $190 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $228 | $1,007 | $1,494 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $293 | $557 |