| Family psychotherapy without patient CPT 90846 • Mental Health | $80 | $127 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $92 | $131 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $44 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $135 | $147 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $108 | $162 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $126 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $314 | $349 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $241 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $43 | $88 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $133 | $151 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $83 | $90 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $72 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $60 | $111 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $115 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $74 | $141 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $286 | $288 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $69 | $76 | $88 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $84 | $92 | $100 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $122 | $142 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $133 | $191 |
| Office visit established patient minimal CPT 99211 • Office Visits | $9 | $27 | $43 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $48 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $49 | $67 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $77 | $126 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $43 | $88 | $134 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $98 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $128 | $149 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $29 | $138 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $83 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $76 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $85 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $75 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $99 | $119 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $50 | $91 |
| Consultation office high complexity CPT 99245 • Office Visits | $208 | $239 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $524 | $694 | $864 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $44 | $51 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,084 | $1,107 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $197 | $257 | $318 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $731 | $1,115 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $515 | $582 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $135 | $240 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $856 | $996 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $374 | $718 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $56 | $109 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $768 | $1,506 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $340 | $495 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $447 | $984 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $462 | $513 | $564 |