| Family psychotherapy without patient CPT 90846 • Mental Health | $110 | $125 | $147 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $115 | $134 | $153 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $33 | $38 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $191 | $245 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $207 | $321 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $155 | $189 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $194 | $506 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $87 | $307 | $554 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $95 | $131 | $172 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $46 | $124 | $244 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $76 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $51 | $96 | $137 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $75 | $114 | $177 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $63 | $112 | $211 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $87 | $139 | $278 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $108 | $192 | $424 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $81 | $101 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $76 | $130 | $173 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $193 | $266 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $168 | $239 | $306 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $25 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $52 | $78 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $89 | $126 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $31 | $115 | $179 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $119 | $185 | $250 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $114 | $138 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $177 | $226 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $190 | $261 | $330 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $51 | $55 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $94 | $118 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $118 | $138 | $170 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $82 | $99 | $119 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $99 | $139 | $174 |
| Consultation office low complexity CPT 99243 • Office Visits | $59 | $145 | $173 |
| Consultation office high complexity CPT 99245 • Office Visits | $110 | $267 | $314 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $517 | $901 | $1,363 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $41 | $74 | $97 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,092 | $1,472 | $1,838 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $222 | $337 | $450 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $967 | $1,288 | $1,571 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $476 | $826 | $1,228 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $256 | $441 | $594 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $689 | $1,042 | $1,424 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $537 | $759 | $1,024 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $89 | $181 | $281 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,200 | $1,666 | $2,150 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $518 | $703 | $922 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $295 | $1,028 | $1,848 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $498 | $794 | $1,256 |