| Psychotherapy 60 minutes CPT 90837 • Mental Health | $128 | $265 | $403 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $147 | $232 | $318 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $387 | $387 | $387 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $172 | $172 | $172 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $137 | $200 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $191 | $275 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $48 | $73 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $83 | $278 | $583 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $247 | $348 | $433 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $202 | $342 | $461 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $73 | $564 | $1,012 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $152 | $440 | $651 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $136 | $136 | $136 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $218 | $298 | $338 |
| EMG needle each extremity complete CPT 95886 • Neurology | $116 | $163 | $249 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $193 | $270 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $153 | $226 | $300 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $148 | $243 | $399 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $189 | $318 | $525 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $375 | $438 | $501 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $94 | $139 | $182 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $177 | $263 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $203 | $310 | $412 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $255 | $432 | $521 |
| Office visit established patient minimal CPT 99211 • Office Visits | $28 | $40 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $90 | $110 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $91 | $148 | $178 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $84 | $217 | $267 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $180 | $295 | $354 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $126 | $180 | $250 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $255 | $339 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $252 | $406 | $530 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $79 | $97 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $91 | $142 | $179 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $207 | $257 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $91 | $143 | $179 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $113 | $221 | $282 |
| Consultation office low complexity CPT 99243 • Office Visits | $152 | $232 | $363 |
| Consultation office high complexity CPT 99245 • Office Visits | $278 | $476 | $660 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,476 | $1,852 | $2,228 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $104 | $178 | $252 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,474 | $2,998 | $4,381 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $655 | $769 | $883 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,908 | $3,237 | $3,566 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,343 | $1,853 | $2,363 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $369 | $694 | $1,084 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $988 | $1,969 | $2,937 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $794 | $1,534 | $2,359 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $190 | $268 | $371 |