| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $123 | $158 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $73 | $95 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $87 | $120 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $133 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $48 | $77 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $115 | $147 | $180 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $108 | $197 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $130 | $146 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $192 | $266 | $311 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $100 | $201 | $302 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $39 | $65 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $86 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $80 | $91 | $102 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $79 | $93 | $110 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $57 | $60 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $124 | $162 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $71 | $84 | $92 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $161 | $222 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $42 | $61 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $63 | $90 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $127 | $163 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $142 | $177 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $20 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $46 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $61 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $63 | $95 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $101 | $143 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $106 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $115 | $144 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $96 | $166 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $82 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $82 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $85 | $106 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $85 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $113 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $5 | $66 | $128 |
| Consultation office high complexity CPT 99245 • Office Visits | $18 | $125 | $196 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $509 | $587 | $665 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $26 | $37 | $55 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $984 | $1,106 | $1,203 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $173 | $267 | $361 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $673 | $1,083 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $72 | $356 | $581 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $234 | $426 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $566 | $1,046 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $261 | $506 | $789 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $115 | $232 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $171 | $916 | $1,582 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $383 | $690 |