| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $93 | $109 | $124 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $47 | $54 | $62 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $69 | $80 | $91 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $78 | $85 | $91 |
| Group psychotherapy CPT 90853 • Mental Health | $48 | $48 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $10 | $28 | $45 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $11 | $28 | $45 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $12 | $12 | $12 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $285 | $285 | $286 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $328 | $328 | $328 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $48 | $72 | $96 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $69 | $104 | $138 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $54 | $72 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $43 | $60 | $77 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $20 | $59 | $99 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $118 | $118 | $119 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $78 | $117 | $156 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $47 | $142 | $236 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $31 | $52 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $45 | $76 | $108 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $21 | $93 | $165 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $153 | $153 | $153 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $23 | $45 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $37 | $45 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $45 | $47 | $49 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $33 | $62 | $90 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $45 | $53 | $61 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $45 | $45 | $45 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $45 | $81 | $116 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $45 | $65 | $86 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $5 | $25 | $45 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $38 | $45 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $45 | $70 | $95 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $53 | $61 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $73 | $85 | $97 |
| Consultation office low complexity CPT 99243 • Office Visits | $45 | $45 | $45 |
| Consultation office high complexity CPT 99245 • Office Visits | $45 | $101 | $157 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $45 | $45 | $45 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $3 | $24 | $45 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $916 | $916 | $916 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $145 | $145 | $145 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $45 | $65 | $85 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $275 | $275 | $275 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $117 | $176 | $234 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $45 | $313 | $580 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $317 | $317 | $317 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $13 | $43 | $72 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $139 | $139 | $139 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $45 | $52 | $58 |