| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $93 | $135 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $76 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $105 | $124 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $69 | $119 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $45 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $70 | $70 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $151 | $271 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $199 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $223 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $80 | $80 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $93 | $164 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $166 | $197 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $217 | $259 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $349 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $72 | $87 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $40 | $110 | $182 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $117 | $223 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $66 | $195 | $282 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $49 | $105 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $53 | $76 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $25 | $57 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $93 | $184 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $53 | $142 | $198 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $110 | $175 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $124 | $160 | $185 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $185 | $347 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $79 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $91 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $86 | $143 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $88 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $137 | $147 |
| Consultation office straightforward CPT 99241 • Office Visits | $25 | $25 | $25 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $115 | $170 |
| Consultation office high complexity CPT 99245 • Office Visits | $66 | $194 | $260 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $30 | $30 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $483 | $483 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $379 | $729 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $30 | $30 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $30 | $30 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $30 | $30 |
| Excision chalazion single CPT 67800 • Ophthalmology | $12 | $12 | $12 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $772 | $772 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |