| Family psychotherapy with patient CPT 90847 • Mental Health | $87 | $131 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $44 | $47 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $135 | $137 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $359 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $498 | $498 | $498 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $127 | $127 | $128 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $173 | $185 |
| EMG needle each extremity complete CPT 95886 • Neurology | $112 | $112 | $112 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $96 | $102 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $127 | $127 | $128 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $95 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $188 | $200 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $305 | $324 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $69 | $77 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $110 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $135 | $149 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $210 | $228 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $25 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $52 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $71 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $98 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $171 | $172 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $87 | $164 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $128 | $164 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $140 | $184 | $214 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $61 | $82 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $62 | $82 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $79 | $110 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $59 | $82 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $117 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $21 | $48 | $92 |
| Consultation office high complexity CPT 99245 • Office Visits | $172 | $221 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $589 | $589 | $589 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $47 | $47 | $47 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $676 | $1,322 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $546 | $610 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $30 | $30 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $84 | $137 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $586 | $1,141 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $328 | $625 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $221 | $412 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $583 | $583 | $583 |
| Excision chalazion single CPT 67800 • Ophthalmology | $30 | $30 | $30 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $979 | $979 | $979 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $21 | $21 | $21 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $98 | $98 | $98 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $93 | $93 |