| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $144 | $226 | $308 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $242 | $334 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $123 | $185 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $97 | $176 | $255 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $157 | $212 | $266 |
| Group psychotherapy CPT 90853 • Mental Health | $50 | $56 | $62 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $8 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $131 | $237 | $344 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $135 | $244 | $353 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $136 | $244 | $352 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $147 | $243 | $338 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $418 | $704 | $990 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $105 | $169 | $291 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $149 | $174 | $211 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $116 | $135 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $158 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $111 | $119 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $202 | $349 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $218 | $274 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $516 | $747 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $96 | $139 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $148 | $216 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $157 | $216 | $322 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $225 | $425 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $29 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $72 | $109 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $103 | $174 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $119 | $247 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $149 | $198 | $278 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $71 | $126 | $161 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $96 | $169 | $253 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $235 | $338 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $83 | $111 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $73 | $113 | $154 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $93 | $145 | $232 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $114 | $157 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $150 | $222 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $149 | $173 |
| Consultation office high complexity CPT 99245 • Office Visits | $178 | $291 | $411 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $545 | $1,080 | $1,614 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $69 | $94 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $2,086 | $3,043 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $233 | $382 | $531 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,302 | $2,060 | $2,818 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $605 | $837 | $1,301 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $772 | $772 | $772 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $1,318 | $1,922 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $323 | $863 | $1,403 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $103 | $198 | $293 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,065 | $3,065 | $3,065 |