| Family psychotherapy without patient CPT 90846 • Mental Health | $111 | $152 | $219 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $82 | $143 | $229 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $39 | $63 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $62 | $167 | $320 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $91 | $188 | $302 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $190 | $301 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $492 | $866 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $452 | $889 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $123 | $244 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $76 | $188 | $340 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $80 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $43 | $62 | $82 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $54 | $136 | $242 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $175 | $292 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $114 | $236 | $381 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $102 | $330 | $623 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $96 | $158 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $65 | $152 | $245 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $224 | $366 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $142 | $301 | $483 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $26 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $51 | $76 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $43 | $99 | $200 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $69 | $153 | $281 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $102 | $227 | $395 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $131 | $176 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $193 | $279 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $163 | $274 | $382 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $64 | $105 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $116 | $170 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $96 | $160 | $253 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $70 | $115 | $175 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $99 | $166 | $247 |
| Consultation office low complexity CPT 99243 • Office Visits | $51 | $147 | $246 |
| Consultation office high complexity CPT 99245 • Office Visits | $110 | $278 | $454 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $517 | $853 | $1,362 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $60 | $83 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,092 | $1,749 | $2,552 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $189 | $369 | $531 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,017 | $1,735 | $2,370 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $476 | $781 | $1,104 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $219 | $433 | $647 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $689 | $1,164 | $1,610 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $497 | $827 | $1,207 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $78 | $151 | $246 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $918 | $1,626 | $2,560 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $488 | $800 | $1,116 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $295 | $506 | $735 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $425 | $832 | $1,383 |