| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $235 | $319 | $404 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $102 | $147 | $191 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $156 | $219 | $282 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $163 | $232 | $301 |
| Group psychotherapy CPT 90853 • Mental Health | $44 | $60 | $75 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $11 | $15 | $18 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $365 | $386 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $221 | $290 | $331 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $164 | $264 | $364 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $934 | $1,017 | $1,099 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $455 | $866 | $1,278 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $195 | $312 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $188 | $248 |
| EMG needle each extremity complete CPT 95886 • Neurology | $134 | $203 | $271 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $50 | $148 | $245 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $197 | $235 | $305 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $196 | $282 | $367 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $479 | $525 | $571 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $533 | $655 | $777 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $207 | $209 | $211 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $211 | $265 | $318 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $440 | $447 | $458 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $465 | $508 | $586 |
| Office visit established patient minimal CPT 99211 • Office Visits | $26 | $45 | $65 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $72 | $117 | $161 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $156 | $207 | $258 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $302 | $328 | $341 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $421 | $467 | $512 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $212 | $261 | $311 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $333 | $376 | $420 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $445 | $515 | $585 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $48 | $87 | $127 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $203 | $206 | $208 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $301 | $303 | $305 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $89 | $149 | $209 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $202 | $296 |
| Consultation office low complexity CPT 99243 • Office Visits | $188 | $264 | $376 |
| Consultation office high complexity CPT 99245 • Office Visits | $338 | $493 | $588 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,676 | $1,686 | $1,697 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $102 | $117 | $133 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,110 | $3,207 | $3,305 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $541 | $629 | $716 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,917 | $2,987 | $3,058 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $648 | $1,140 | $1,406 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $365 | $591 | $818 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $912 | $1,442 | $1,973 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $664 | $1,054 | $1,443 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $304 | $306 | $308 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,129 | $3,391 | $3,653 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,382 | $1,441 | $1,500 |