| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $289 | $481 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $122 | $238 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $185 | $327 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $81 | $191 | $340 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $60 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $10 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $441 | $441 | $441 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $211 | $393 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $293 | $451 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $183 | $721 | $1,258 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $919 | $1,459 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $173 | $189 | $204 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $152 | $271 |
| EMG needle each extremity complete CPT 95886 • Neurology | $173 | $173 | $173 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $107 | $176 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $109 | $153 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $159 | $183 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $205 | $235 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $454 | $622 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $65 | $82 | $110 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $183 | $254 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $16 | $188 | $378 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $131 | $265 | $499 |
| Office visit established patient minimal CPT 99211 • Office Visits | $2 | $14 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $75 | $114 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $95 | $182 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $84 | $129 | $198 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $133 | $212 | $291 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $95 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $121 | $209 | $297 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $96 | $210 | $397 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $76 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $91 | $181 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $182 | $272 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $96 | $184 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $169 | $261 |
| Consultation office low complexity CPT 99243 • Office Visits | $18 | $138 | $259 |
| Consultation office high complexity CPT 99245 • Office Visits | $167 | $325 | $484 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $758 | $1,415 | $2,071 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $80 | $129 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,904 | $3,904 | $3,904 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $368 | $525 | $681 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $1,822 | $3,615 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $48 | $859 | $1,669 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $296 | $538 | $781 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $747 | $1,606 | $2,465 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $508 | $943 | $1,800 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $168 | $304 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $114 | $2,023 | $3,932 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $759 | $1,707 |