| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $93 | $181 | $268 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $56 | $60 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $68 | $131 | $195 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $202 | $202 | $202 |
| Group psychotherapy CPT 90853 • Mental Health | $48 | $48 | $49 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $2 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $10 | $66 | $122 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $70 | $70 | $70 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $77 | $93 | $109 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $149 | $172 | $194 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $43 | $128 | $213 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $68 | $68 | $68 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $20 | $59 | $99 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $57 | $73 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $16 | $47 | $79 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $49 | $74 | $98 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $52 | $59 | $65 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $111 | $155 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $51 | $153 | $255 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $72 | $73 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $6 | $57 | $107 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $124 | $124 | $124 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $24 | $92 | $160 |
| Office visit established patient minimal CPT 99211 • Office Visits | $15 | $27 | $40 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $3 | $22 | $40 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $20 | $40 | $59 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $93 | $104 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $13 | $77 | $140 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $81 | $114 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $40 | $93 | $146 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $24 | $99 | $173 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $64 | $64 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $40 | $52 | $64 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $77 | $83 | $90 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $28 | $46 | $64 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $8 | $49 | $89 |
| Consultation office low complexity CPT 99243 • Office Visits | $11 | $52 | $93 |
| Consultation office high complexity CPT 99245 • Office Visits | $16 | $111 | $206 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $381 | $463 | $544 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $6 | $23 | $40 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $613 | $613 | $613 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $23 | $23 | $23 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $811 | $811 | $812 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $56 | $215 | $374 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $112 | $143 | $175 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $111 | $111 | $111 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $304 | $304 | $304 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $17 | $50 | $84 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $621 | $621 | $621 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $288 | $336 | $384 |