| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $291 | $437 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $74 | $142 | $209 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $114 | $211 | $308 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $168 | $318 |
| Group psychotherapy CPT 90853 • Mental Health | $32 | $54 | $75 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $9 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $140 | $154 | $168 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $269 | $410 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $128 | $239 | $349 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $216 | $546 | $1,052 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $175 | $307 | $439 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $121 | $135 | $158 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $89 | $258 | $504 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $192 | $285 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $96 | $189 | $282 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $25 | $101 | $154 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $428 | $428 | $428 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $193 | $260 | $326 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $307 | $439 | $572 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $51 | $101 | $176 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $51 | $135 | $249 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $82 | $298 | $430 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $21 | $274 | $540 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $42 | $53 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $45 | $52 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $51 | $100 | $174 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $8 | $110 | $253 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $145 | $242 | $340 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $100 | $170 | $240 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $136 | $230 | $324 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $200 | $293 | $477 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $38 | $65 | $93 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $71 | $121 | $171 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $174 | $246 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $122 | $171 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $155 | $252 |
| Consultation office low complexity CPT 99243 • Office Visits | $45 | $187 | $288 |
| Consultation office high complexity CPT 99245 • Office Visits | $224 | $304 | $455 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $550 | $1,085 | $1,621 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $46 | $84 | $122 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,131 | $3,131 | $3,131 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $651 | $821 | $990 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,097 | $1,993 | $2,888 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $505 | $790 | $1,324 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $788 | $958 | $1,128 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,983 | $1,983 | $1,983 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,445 | $1,802 | $2,159 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $45 | $156 | $268 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,172 | $3,845 | $4,517 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $519 | $942 | $1,366 |