| Family psychotherapy with patient CPT 90847 • Mental Health | $140 | $167 | $208 |
| Group psychotherapy CPT 90853 • Mental Health | $32 | $49 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $82 | $989 | $2,329 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $128 | $379 | $723 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $122 | $350 | $723 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $81 | $343 | $695 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $498 | $818 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $82 | $112 | $153 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $212 | $327 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $90 | $115 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $79 | $102 | $121 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $132 | $138 | $150 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $112 | $142 | $182 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $118 | $195 | $243 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $211 | $310 | $377 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $70 | $98 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $114 | $172 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $165 | $335 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $171 | $249 | $366 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $27 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $63 | $113 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $56 | $106 | $141 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $103 | $195 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $176 | $361 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $120 | $199 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $118 | $167 | $267 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $172 | $247 | $391 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $53 | $77 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $90 | $141 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $149 | $202 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $78 | $107 | $142 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $154 | $208 |
| Consultation office low complexity CPT 99243 • Office Visits | $0 | $78 | $156 |
| Consultation office high complexity CPT 99245 • Office Visits | $0 | $143 | $285 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $614 | $2,896 | $6,280 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $46 | $323 | $723 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,105 | $7,181 | $15,715 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $262 | $1,112 | $2,329 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $311 | $3,839 | $8,409 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $487 | $3,697 | $8,409 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $318 | $1,027 | $2,329 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $813 | $3,382 | $8,409 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $341 | $3,330 | $8,409 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $162 | $369 | $723 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $384 | $5,953 | $15,715 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $681 | $1,508 | $2,329 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $395 | $1,167 | $2,329 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $458 | $3,733 | $8,409 |
| Excision chalazion single CPT 67800 • Ophthalmology | $95 | $402 | $723 |