| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $132 | $154 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $83 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $128 | $139 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $128 | $139 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $58 | $62 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $2 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $62 | $62 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $99 | $99 | $99 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $27 | $27 | $27 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $367 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $86 | $86 | $86 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $81 | $121 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $49 | $49 | $49 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $45 | $45 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $22 | $22 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $56 | $67 | $78 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $88 | $88 | $88 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $184 | $184 | $184 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $60 | $60 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $61 | $93 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $76 | $122 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $162 | $172 | $183 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $22 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $39 | $49 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $37 | $44 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $96 | $110 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $137 | $143 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $49 | $49 | $49 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $30 | $30 | $30 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $168 | $168 | $168 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $19 | $74 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $129 | $129 | $130 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $129 | $129 | $130 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $35 | $82 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $10 | $70 | $129 |
| Consultation office low complexity CPT 99243 • Office Visits | $93 | $119 | $145 |
| Consultation office high complexity CPT 99245 • Office Visits | $191 | $191 | $191 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $451 | $451 | $451 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $28 | $28 | $28 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $848 | $989 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $99 | $168 | $237 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $210 | $210 | $210 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $483 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $44 | $58 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $373 | $715 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $391 | $456 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $82 | $95 | $109 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $586 | $1,142 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $50 | $50 | $50 |