| Group psychotherapy CPT 90853 • Mental Health | $17 | $22 | $26 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $29 | $29 | $29 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $55 | $55 | $55 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $119 | $119 | $119 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $40 | $40 | $40 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $40 | $40 | $40 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $36 | $36 | $36 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $57 | $57 | $57 |
| EMG needle each extremity complete CPT 95886 • Neurology | $32 | $71 | $110 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $34 | $34 | $34 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $41 | $41 | $41 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $205 | $205 | $205 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $52 | $63 | $74 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $59 | $83 | $124 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $95 | $123 | $174 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $126 | $155 | $211 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $18 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $36 | $53 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $43 | $63 | $80 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $79 | $114 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $116 | $188 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $59 | $73 | $86 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $115 | $137 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $153 | $182 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $35 | $40 | $44 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $46 | $62 | $83 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $67 | $92 | $125 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $58 | $71 | $85 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $82 | $101 | $120 |
| Consultation office low complexity CPT 99243 • Office Visits | $63 | $63 | $63 |
| Consultation office high complexity CPT 99245 • Office Visits | $129 | $129 | $129 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $250 | $250 | $250 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $16 | $16 | $16 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,262 | $1,262 | $1,262 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $146 | $146 | $146 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $493 | $493 | $493 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $544 | $544 | $544 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $106 | $106 | $106 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $335 | $457 | $580 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $244 | $489 | $771 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $41 | $92 | $130 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $135 | $135 | $135 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $224 | $224 | $224 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $216 | $216 | $216 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $205 | $205 | $205 |
| Excision chalazion single CPT 67800 • Ophthalmology | $110 | $110 | $110 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $265 | $265 | $265 |