| Family psychotherapy without patient CPT 90846 • Mental Health | $77 | $122 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $98 | $126 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $50 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $135 | $199 | $264 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $155 | $200 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $116 | $151 | $187 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $48 | $55 | $62 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $190 | $308 | $426 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $31 | $72 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $103 | $136 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $66 | $88 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $40 | $42 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $49 | $76 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $58 | $61 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $107 | $114 | $121 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $190 | $215 | $240 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $63 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $82 | $103 | $110 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $126 | $163 | $199 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $158 | $210 | $250 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $20 | $47 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $54 | $73 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $128 | $185 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $87 | $144 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $78 | $124 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $108 | $154 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $159 | $187 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $86 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $58 | $105 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $84 | $124 | $154 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $59 | $106 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $85 | $123 | $149 |
| Consultation office straightforward CPT 99241 • Office Visits | $29 | $29 | $29 |
| Consultation office low complexity CPT 99243 • Office Visits | $85 | $139 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $167 | $225 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $480 | $565 | $651 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $40 | $55 | $70 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $956 | $1,204 | $1,526 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $259 | $318 | $377 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $875 | $1,085 | $1,295 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $465 | $510 | $581 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $302 | $405 | $508 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $801 | $1,075 | $1,349 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $521 | $684 | $961 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $164 | $190 | $216 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,197 | $1,433 | $1,669 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $516 | $677 | $837 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $327 | $827 | $1,285 |