| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $145 | $214 | $258 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $46 | $80 | $123 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $138 | $198 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $77 | $129 | $207 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $48 | $78 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $5 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $91 | $153 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $139 | $248 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $12 | $109 | $206 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $111 | $283 | $387 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $374 | $504 | $759 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $75 | $101 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $32 | $96 | $159 |
| EMG needle each extremity complete CPT 95886 • Neurology | $86 | $120 | $172 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $52 | $118 | $184 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $56 | $135 | $236 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $73 | $162 | $280 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $36 | $204 | $371 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $47 | $290 | $561 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $61 | $73 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $8 | $116 | $183 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $60 | $185 | $279 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $191 | $242 | $289 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $18 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $57 | $73 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $77 | $123 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $46 | $102 | $182 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $13 | $127 | $246 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $49 | $96 | $174 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $128 | $177 | $235 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $137 | $228 | $348 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $68 | $97 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $7 | $66 | $124 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $131 | $179 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $68 | $89 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $48 | $111 | $184 |
| Consultation office low complexity CPT 99243 • Office Visits | $171 | $191 | $211 |
| Consultation office high complexity CPT 99245 • Office Visits | $230 | $307 | $384 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $532 | $776 | $1,036 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $8 | $69 | $131 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $848 | $1,556 | $2,263 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $178 | $396 | $642 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $524 | $1,404 | $2,283 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $469 | $845 | $1,220 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $74 | $273 | $449 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $663 | $965 | $1,518 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $78 | $551 | $1,220 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $88 | $134 | $194 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,142 | $2,104 | $3,065 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $238 | $569 | $953 |