| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $135 | $135 | $135 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $82 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $93 | $121 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $121 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $21 | $21 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $102 | $102 | $102 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $110 | $191 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $117 | $125 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $371 | $375 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $697 | $697 | $697 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $59 | $91 | $123 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $118 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $49 | $49 | $49 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $90 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $59 | $91 | $122 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $56 | $95 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $98 | $137 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $172 | $229 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $45 | $58 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $173 | $173 | $173 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $159 | $161 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $193 | $196 | $200 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $34 | $37 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $39 | $47 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $47 | $65 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $65 | $101 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $171 | $171 | $171 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $54 | $78 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $128 | $128 | $128 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $262 | $325 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $37 | $37 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $49 | $67 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $71 | $111 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $47 | $63 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $151 | $172 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $93 | $156 |
| Consultation office high complexity CPT 99245 • Office Visits | $170 | $212 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $591 | $591 | $591 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $36 | $36 | $36 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,107 | $1,107 | $1,107 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $214 | $214 | $214 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $526 | $1,021 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $437 | $460 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $260 | $260 | $260 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $699 | $699 | $699 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $270 | $510 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $58 | $86 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $571 | $1,113 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $258 | $485 |