| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $200 | $200 | $200 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $77 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $116 | $124 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $137 | $148 | $160 |
| Group psychotherapy CPT 90853 • Mental Health | $49 | $49 | $50 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $173 | $173 | $173 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $33 | $33 | $33 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $13 | $69 | $126 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $372 | $372 | $372 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $425 | $425 | $425 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $124 | $124 | $124 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $79 | $126 | $174 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $51 | $74 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $93 | $124 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $148 | $148 | $148 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $196 | $196 | $196 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $112 | $202 | $292 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $75 | $94 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $37 | $98 | $160 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $242 | $242 | $242 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $16 | $16 | $16 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $18 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $4 | $35 | $67 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $24 | $67 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $107 | $134 | $161 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $214 | $214 | $215 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $33 | $65 | $97 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $13 | $23 | $33 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $33 | $155 | $278 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $45 | $57 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $33 | $58 | $84 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $128 | $135 | $143 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $84 | $96 | $109 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $132 | $144 | $155 |
| Consultation office low complexity CPT 99243 • Office Visits | $180 | $180 | $180 |
| Consultation office high complexity CPT 99245 • Office Visits | $28 | $177 | $326 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $234 | $350 | $467 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $53 | $61 | $69 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,180 | $1,180 | $1,180 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $30 | $30 | $30 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $845 | $1,025 | $1,206 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $452 | $549 | $645 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $36 | $36 | $36 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $159 | $159 | $159 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $96 | $96 | $96 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $100 | $100 | $100 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $319 | $319 | $319 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $50 | $286 | $521 |