| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $148 | $207 | $265 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $93 | $114 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $115 | $150 | $186 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $119 | $155 | $192 |
| Group psychotherapy CPT 90853 • Mental Health | $40 | $43 | $45 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $69 | $108 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $165 | $234 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $194 | $194 | $194 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $338 | $460 | $582 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $407 | $559 | $712 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $66 | $94 | $117 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $170 | $221 | $323 |
| EMG needle each extremity complete CPT 95886 • Neurology | $103 | $143 | $182 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $94 | $97 | $101 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $117 | $145 | $193 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $60 | $91 | $122 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $157 | $171 | $184 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $110 | $231 | $351 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $81 | $100 | $120 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $99 | $169 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $131 | $199 | $258 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $275 | $300 | $325 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $10 | $14 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $51 | $72 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $74 | $118 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $123 | $149 | $162 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $129 | $228 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $95 | $160 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $30 | $123 | $215 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $196 | $315 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $46 | $61 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $71 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $96 | $162 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $72 | $114 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $113 | $137 | $167 |
| Consultation office low complexity CPT 99243 • Office Visits | $130 | $162 | $194 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $218 | $353 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $544 | $1,058 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $46 | $62 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,019 | $2,019 | $2,019 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $354 | $354 | $354 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $951 | $1,872 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $528 | $696 | $863 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $516 | $516 | $516 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,281 | $1,281 | $1,281 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $482 | $934 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $168 | $168 | $168 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $1,037 | $2,045 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $459 | $887 |