| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $207 | $269 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $95 | $111 | $142 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $170 | $209 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $172 | $217 |
| Group psychotherapy CPT 90853 • Mental Health | $57 | $67 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $10 | $10 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $283 | $283 | $283 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $202 | $272 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $178 | $178 | $178 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $51 | $51 | $51 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $729 | $729 | $729 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $175 | $239 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $74 | $132 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $40 | $40 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $81 | $81 | $81 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $64 | $105 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $110 | $166 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $79 | $79 | $79 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $609 | $609 | $609 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $56 | $65 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $83 | $100 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $127 | $151 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $215 | $268 | $375 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $34 | $41 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $49 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $88 | $104 | $135 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $94 | $124 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $111 | $154 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $78 | $139 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $197 | $251 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $160 | $189 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $72 | $110 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $106 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $84 | $114 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $129 | $130 | $133 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $87 | $115 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $85 | $128 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $202 | $229 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,253 | $1,253 | $1,253 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $94 | $94 | $94 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,775 | $2,421 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $308 | $308 | $308 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,233 | $2,233 | $2,233 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $557 | $631 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $482 | $482 | $482 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $781 | $1,533 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $521 | $651 | $782 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $176 | $176 | $176 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,636 | $1,636 | $1,636 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,056 | $1,056 | $1,056 |