| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $156 | $245 | $334 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $95 | $131 | $166 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $127 | $191 | $254 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $109 | $188 | $266 |
| Group psychotherapy CPT 90853 • Mental Health | $71 | $74 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $8 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $108 | $226 | $344 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $116 | $235 | $353 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $117 | $198 | $279 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $147 | $289 | $360 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $147 | $284 | $421 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $108 | $169 | $291 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $150 | $211 |
| EMG needle each extremity complete CPT 95886 • Neurology | $138 | $195 | $253 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $112 | $137 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $56 | $95 | $119 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $131 | $137 | $143 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $250 | $300 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $460 | $468 | $485 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $93 | $106 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $162 | $189 | $216 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $158 | $322 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $182 | $425 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $27 | $32 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $39 | $58 | $69 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $110 | $116 | $128 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $94 | $150 | $247 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $219 | $283 | $346 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $154 | $157 | $161 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $253 | $253 | $253 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $16 | $177 | $338 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $96 | $96 | $96 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $154 | $154 | $154 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $232 | $232 | $232 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $157 | $157 | $157 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $147 | $222 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $111 | $173 |
| Consultation office high complexity CPT 99245 • Office Visits | $9 | $225 | $411 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $534 | $982 | $1,430 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $69 | $101 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $2,086 | $3,043 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $635 | $635 | $635 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,046 | $1,932 | $2,818 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $481 | $755 | $1,301 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $401 | $772 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,922 | $1,922 | $1,922 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $520 | $961 | $1,403 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $88 | $163 | $237 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,065 | $3,065 | $3,065 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $494 | $912 | $1,331 |