| Family psychotherapy without patient CPT 90846 • Mental Health | $117 | $152 | $222 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $168 | $272 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $46 | $75 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $60 | $116 | $239 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $168 | $255 | $410 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $225 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $365 | $699 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $356 | $809 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $110 | $182 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $90 | $110 | $132 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $90 | $183 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $116 | $170 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $62 | $128 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $100 | $164 | $254 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $99 | $200 | $332 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $278 | $382 | $544 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $51 | $84 | $148 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $76 | $132 | $221 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $122 | $201 | $322 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $171 | $244 | $409 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $27 | $50 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $32 | $50 | $88 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $82 | $125 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $71 | $138 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $95 | $191 | $295 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $137 | $180 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $101 | $162 | $263 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $135 | $229 | $366 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $55 | $77 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $59 | $85 | $130 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $139 | $184 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $126 | $254 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $94 | $142 | $218 |
| Consultation office straightforward CPT 99241 • Office Visits | $74 | $74 | $74 |
| Consultation office low complexity CPT 99243 • Office Visits | $73 | $176 | $289 |
| Consultation office high complexity CPT 99245 • Office Visits | $142 | $308 | $508 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $614 | $733 | $911 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $42 | $55 | $81 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $992 | $1,206 | $1,791 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $331 | $363 | $408 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $667 | $1,094 | $1,648 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $487 | $794 | $1,208 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $356 | $391 | $445 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $813 | $1,066 | $1,252 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $640 | $892 | $1,209 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $127 | $160 | $187 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $227 | $1,357 | $2,004 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $613 | $718 | $824 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $245 | $595 | $935 |