| Family psychotherapy without patient CPT 90846 • Mental Health | $86 | $116 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $89 | $113 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $23 | $45 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $119 | $119 | $119 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $65 | $100 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $94 | $114 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $259 | $313 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $317 | $317 | $317 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $45 | $78 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $132 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $43 | $43 | $43 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $45 | $46 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $63 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $123 | $129 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $70 | $123 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $96 | $191 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $62 | $66 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $91 | $93 | $96 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $110 | $129 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $116 | $160 | $188 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $23 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $38 | $45 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $57 | $78 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $62 | $80 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $94 | $124 | $154 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $95 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $117 | $143 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $96 | $155 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $81 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $73 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $82 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $74 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $90 | $110 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $56 | $82 |
| Consultation office high complexity CPT 99245 • Office Visits | $191 | $223 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $465 | $465 | $465 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $39 | $39 | $39 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,002 | $1,002 | $1,002 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $209 | $209 | $209 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $478 | $927 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $426 | $454 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $142 | $254 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $635 | $635 | $635 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $246 | $463 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $84 | $137 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $358 | $1,015 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $226 | $423 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $266 | $510 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $506 | $506 | $506 |