| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $144 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $59 | $59 | $59 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $116 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $81 | $119 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $47 | $47 | $47 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $9 | $9 | $9 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $55 | $80 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $67 | $67 | $67 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $311 | $331 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $86 | $86 | $86 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $50 | $50 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $123 | $166 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $45 | $45 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $112 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $69 | $75 | $81 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $71 | $71 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $58 | $74 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $41 | $85 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $131 | $132 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $22 | $26 | $30 |
| Office visit established patient minimal CPT 99211 • Office Visits | $4 | $4 | $4 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $20 | $37 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $13 | $62 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $77 | $118 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $147 | $160 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $30 | $30 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $13 | $13 | $13 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $96 | $96 | $96 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $19 | $19 | $19 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $10 | $10 | $10 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $30 | $30 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $97 | $97 | $97 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $97 | $97 |
| Consultation office low complexity CPT 99243 • Office Visits | $58 | $71 | $83 |
| Consultation office high complexity CPT 99245 • Office Visits | $18 | $18 | $18 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $373 | $373 | $373 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $26 | $26 | $26 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $846 | $988 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $253 | $253 | $253 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $210 | $210 | $210 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $52 | $52 | $52 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $170 | $170 | $170 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $265 | $501 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $84 | $320 | $557 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $109 | $113 | $116 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $183 | $662 | $1,141 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |