| Group psychotherapy CPT 90853 • Mental Health | $38 | $58 | $71 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $266 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $181 | $308 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $264 | $327 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $513 | $851 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $519 | $826 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $165 | $165 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $338 | $362 | $411 |
| EMG needle each extremity complete CPT 95886 • Neurology | $64 | $143 | $249 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $233 | $251 | $270 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $164 | $226 | $287 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $145 | $247 | $399 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $150 | $376 | $525 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $277 | $345 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $87 | $116 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $145 | $168 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $219 | $338 | $412 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $282 | $382 | $521 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $34 | $53 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $61 | $84 | $107 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $101 | $126 | $177 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $108 | $199 | $267 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $198 | $231 | $281 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $137 | $236 | $371 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $189 | $277 | $371 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $232 | $423 | $530 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $123 | $238 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $97 | $159 | $238 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $140 | $209 | $281 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $127 | $169 | $238 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $187 | $241 | $282 |
| Consultation office low complexity CPT 99243 • Office Visits | $167 | $284 | $363 |
| Consultation office high complexity CPT 99245 • Office Visits | $265 | $507 | $660 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,678 | $1,678 | $1,678 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $179 | $179 | $179 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,851 | $3,851 | $3,851 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $1,118 | $1,118 | $1,118 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $3,954 | $3,954 | $3,954 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $2,076 | $2,076 | $2,076 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $970 | $970 | $970 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $2,661 | $2,661 | $2,661 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $729 | $1,432 | $2,135 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $334 | $334 | $334 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $5,343 | $5,343 | $5,343 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,715 | $1,715 | $1,715 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $3,178 | $3,178 | $3,178 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $2,001 | $2,001 | $2,001 |
| Excision chalazion single CPT 67800 • Ophthalmology | $420 | $420 | $420 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $2,496 | $2,496 | $2,496 |