| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $126 | $180 | $235 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $68 | $70 | $72 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $132 | $157 | $181 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $112 | $150 | $188 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $47 | $50 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $5 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $138 | $161 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $42 | $70 | $97 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $93 | $123 | $152 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $50 | $186 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $50 | $210 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $44 | $76 | $107 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $113 | $151 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $97 | $154 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $84 | $120 | $157 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $57 | $130 | $203 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $56 | $57 | $57 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $84 | $201 | $317 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $259 | $259 | $259 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $6 | $65 | $124 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $9 | $19 | $30 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $42 | $42 | $42 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $187 | $201 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $9 | $17 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $45 | $47 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $60 | $90 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $8 | $25 | $42 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $30 | $102 | $175 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $8 | $78 | $148 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $164 | $164 | $164 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $180 | $209 | $239 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $29 | $72 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $42 | $79 | $115 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $92 | $108 | $123 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $42 | $79 | $115 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $126 | $126 | $127 |
| Consultation office low complexity CPT 99243 • Office Visits | $42 | $42 | $42 |
| Consultation office high complexity CPT 99245 • Office Visits | $165 | $217 | $269 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $230 | $371 | $512 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $42 | $62 | $81 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $983 | $983 | $983 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $163 | $163 | $163 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $116 | $635 | $1,155 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $76 | $420 | $763 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $42 | $126 | $211 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $707 | $707 | $707 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $42 | $59 | $76 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $121 | $121 | $121 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $42 | $562 | $1,082 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $92 | $354 | $615 |