| Group psychotherapy CPT 90853 • Mental Health | $34 | $50 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $90 | $138 | $201 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $89 | $207 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $170 | $206 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $387 | $464 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $483 | $538 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $62 | $95 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $130 | $197 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $58 | $64 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $81 | $110 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $81 | $101 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $165 | $165 | $165 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $87 | $95 | $104 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $229 | $257 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $47 | $72 | $112 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $102 | $128 | $173 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $213 | $258 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $191 | $341 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $29 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $46 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $95 | $140 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $119 | $198 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $162 | $187 | $223 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $129 | $145 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $131 | $172 | $203 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $182 | $271 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $44 | $83 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $82 | $111 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $99 | $141 | $186 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $97 | $117 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $101 | $138 | $178 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $103 | $177 |
| Consultation office high complexity CPT 99245 • Office Visits | $213 | $252 | $330 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $601 | $720 | $839 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $46 | $55 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,784 | $1,784 | $1,784 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $372 | $372 | $372 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,047 | $1,349 | $1,652 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $576 | $763 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $453 | $453 | $453 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,126 | $1,126 | $1,126 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $521 | $672 | $822 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $88 | $130 | $172 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,797 | $1,797 | $1,797 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $495 | $624 | $753 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $272 | $459 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $575 | $688 |
| Excision chalazion single CPT 67800 • Ophthalmology | $155 | $155 | $155 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $30 | $620 | $1,209 |