| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $118 | $222 | $326 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $88 | $112 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $102 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $77 | $110 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $25 | $27 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $48 | $48 | $48 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $124 | $218 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $243 | $353 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $477 | $587 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $317 | $348 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $37 | $73 | $109 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $219 | $278 |
| EMG needle each extremity complete CPT 95886 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $46 | $68 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $87 | $98 | $109 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $165 | $196 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $163 | $169 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $260 | $273 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $109 | $183 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $193 | $282 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $86 | $121 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $131 | $170 | $222 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $22 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $49 | $56 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $45 | $57 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $78 | $127 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $111 | $149 | $186 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $101 | $207 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $103 | $104 | $105 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $155 | $186 | $222 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $36 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $67 | $102 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $138 | $297 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $74 | $117 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $82 | $107 | $136 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $60 | $90 |
| Consultation office high complexity CPT 99245 • Office Visits | $191 | $238 | $285 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $589 | $673 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $49 | $49 | $49 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $905 | $905 | $905 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $210 | $228 | $245 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $354 | $677 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $385 | $434 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $146 | $221 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $663 | $936 | $1,208 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $290 | $508 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $95 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $657 | $1,283 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $322 | $541 |