| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $153 | $182 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $66 | $69 | $72 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $128 | $130 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $137 | $147 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $55 | $55 | $55 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $3 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $11 | $11 | $11 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $74 | $74 | $74 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $56 | $56 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $374 | $374 | $374 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $81 | $81 | $81 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $35 | $35 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $78 | $78 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $57 | $57 | $57 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $44 | $71 | $97 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $53 | $96 | $139 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $166 | $189 | $211 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $22 | $129 | $237 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $32 | $53 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $2 | $30 | $58 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $63 | $95 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $133 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $181 | $185 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $139 | $139 | $139 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $13 | $13 | $13 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $19 | $19 | $19 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $110 | $110 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $110 | $110 | $110 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $130 | $130 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $7 | $7 | $7 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $10 | $10 | $10 |
| Consultation office low complexity CPT 99243 • Office Visits | $12 | $12 | $12 |
| Consultation office high complexity CPT 99245 • Office Visits | $92 | $92 | $92 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $96 | $96 | $96 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $5 | $5 | $5 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $792 | $792 | $792 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $237 | $237 | $237 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $406 | $406 | $406 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $374 | $374 | $374 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $43 | $43 | $43 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $358 | $358 | $358 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $391 | $391 | $391 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $55 | $55 | $55 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $89 | $89 | $89 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $50 | $50 | $50 |