| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $276 | $428 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $58 | $136 | $213 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $205 | $327 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $216 | $341 |
| Group psychotherapy CPT 90853 • Mental Health | $46 | $69 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $15 | $15 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $45 | $243 | $441 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $103 | $212 | $393 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $451 | $451 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $1,258 | $1,258 | $1,258 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $189 | $189 | $189 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $94 | $132 | $169 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $213 | $232 | $271 |
| EMG needle each extremity complete CPT 95886 • Neurology | $152 | $152 | $152 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $123 | $123 | $123 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $148 | $184 | $220 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $52 | $118 | $183 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $586 | $586 | $586 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $335 | $335 | $335 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $110 | $110 | $110 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $45 | $149 | $254 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $103 | $190 | $304 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $215 | $382 | $499 |
| Office visit established patient minimal CPT 99211 • Office Visits | $45 | $46 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $45 | $79 | $114 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $45 | $114 | $182 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $93 | $128 | $198 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $45 | $204 | $362 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $45 | $117 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $45 | $171 | $297 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $45 | $204 | $397 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $36 | $74 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $45 | $113 | $181 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $45 | $159 | $272 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $115 | $184 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $113 | $187 | $261 |
| Consultation office low complexity CPT 99243 • Office Visits | $45 | $137 | $203 |
| Consultation office high complexity CPT 99245 • Office Visits | $45 | $277 | $484 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $45 | $940 | $1,835 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $87 | $129 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,904 | $3,904 | $3,904 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $815 | $815 | $815 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $45 | $1,830 | $3,615 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $374 | $1,022 | $1,669 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $991 | $991 | $991 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $554 | $1,510 | $2,465 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $404 | $1,102 | $1,800 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $376 | $376 | $376 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $21 | $1,976 | $3,932 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $45 | $846 | $1,647 |