| Family psychotherapy with patient CPT 90847 • Mental Health | $99 | $131 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $43 | $78 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $40 | $79 | $123 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $76 | $108 | $126 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $113 | $123 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $340 | $409 | $545 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $115 | $412 | $653 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $48 | $70 | $104 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $72 | $100 | $149 |
| EMG needle each extremity complete CPT 95886 • Neurology | $87 | $108 | $149 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $35 | $52 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $99 | $141 | $176 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $119 | $126 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $69 | $109 | $164 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $254 | $260 | $268 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $40 | $78 | $122 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $71 | $128 | $216 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $115 | $179 | $283 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $157 | $217 | $326 |
| Office visit established patient minimal CPT 99211 • Office Visits | $7 | $23 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $63 | $111 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $57 | $94 | $145 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $83 | $146 | $218 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $124 | $203 | $349 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $82 | $143 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $174 | $261 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $163 | $216 | $396 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $78 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $107 | $142 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $90 | $123 | $152 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $58 | $99 | $142 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $92 | $126 | $156 |
| Consultation office low complexity CPT 99243 • Office Visits | $51 | $120 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $0 | $177 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $517 | $535 | $567 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $20 | $30 | $36 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,092 | $1,315 | $1,754 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $189 | $232 | $277 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $622 | $886 | $1,019 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $470 | $567 | $757 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $134 | $211 | $279 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $689 | $831 | $1,108 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $340 | $450 | $507 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $57 | $84 | $106 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,095 | $1,268 | $1,601 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $449 | $473 | $488 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $295 | $340 | $409 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $424 | $509 | $679 |
| Excision chalazion single CPT 67800 • Ophthalmology | $101 | $120 | $138 |