| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $178 | $178 | $179 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $78 | $89 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $116 | $116 | $116 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $121 | $121 | $121 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $45 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $12 | $12 | $12 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $83 | $97 | $111 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $99 | $99 | $99 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $399 | $505 | $611 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $99 | $167 | $235 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $118 | $118 | $118 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $89 | $129 | $170 |
| EMG needle each extremity complete CPT 95886 • Neurology | $104 | $127 | $151 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $19 | $19 | $19 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $66 | $66 | $66 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $28 | $137 | $244 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $78 | $180 | $281 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $185 | $351 | $518 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $20 | $74 | $129 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $33 | $107 | $180 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $108 | $182 | $255 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $90 | $186 | $279 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $30 | $40 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $23 | $47 | $71 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $71 | $98 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $8 | $69 | $154 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $119 | $149 | $179 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $40 | $76 | $113 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $11 | $107 | $204 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $163 | $223 | $283 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $64 | $67 | $69 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $44 | $74 | $104 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $44 | $97 | $150 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $81 | $106 | $130 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $42 | $112 | $182 |
| Consultation office low complexity CPT 99243 • Office Visits | $122 | $122 | $122 |
| Consultation office high complexity CPT 99245 • Office Visits | $72 | $72 | $72 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $374 | $374 | $374 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $24 | $24 | $24 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,000 | $1,000 | $1,000 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $174 | $174 | $174 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $668 | $668 | $668 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $93 | $93 | $93 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $261 | $261 | $261 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $906 | $906 | $906 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $463 | $463 | $463 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $11 | $11 | $11 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $721 | $721 | $721 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $63 | $63 | $63 |