| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $64 | $80 | $101 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $88 | $112 | $134 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $61 | $133 | $170 |
| Group psychotherapy CPT 90853 • Mental Health | $33 | $47 | $69 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $63 | $796 | $2,223 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $43 | $283 | $747 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $98 | $336 | $747 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $55 | $254 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $77 | $360 | $461 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $48 | $101 | $126 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $60 | $132 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $75 | $98 | $144 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $64 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $85 | $104 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $89 | $142 | $231 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $88 | $147 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $149 | $295 | $500 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $67 | $114 | $182 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $178 | $263 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $142 | $208 | $403 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $299 | $506 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $31 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $63 | $105 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $118 | $178 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $86 | $146 | $262 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $170 | $253 | $354 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $79 | $152 | $250 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $122 | $214 | $339 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $155 | $289 | $501 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $42 | $68 | $97 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $66 | $108 | $179 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $94 | $171 | $257 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $10 | $100 | $179 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $96 | $163 | $265 |
| Consultation office low complexity CPT 99243 • Office Visits | $5 | $133 | $301 |
| Consultation office high complexity CPT 99245 • Office Visits | $170 | $347 | $551 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $695 | $2,198 | $4,121 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $76 | $284 | $747 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $963 | $5,780 | $16,212 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $185 | $803 | $2,223 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,048 | $3,573 | $8,789 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $235 | $2,659 | $8,789 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $195 | $832 | $2,223 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $687 | $3,314 | $8,789 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $501 | $2,724 | $8,789 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $83 | $308 | $747 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,105 | $5,003 | $16,212 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $385 | $1,137 | $2,223 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $244 | $896 | $2,223 |