| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $150 | $262 | $375 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $71 | $117 | $185 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $112 | $172 | $254 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $194 | $265 |
| Group psychotherapy CPT 90853 • Mental Health | $58 | $64 | $71 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $90 | $185 | $344 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $192 | $353 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $206 | $352 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $310 | $553 | $981 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $147 | $288 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $127 | $159 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $178 | $211 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $108 | $118 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $105 | $137 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $114 | $119 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $132 | $206 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $208 | $274 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $439 | $747 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $56 | $84 | $139 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $102 | $142 | $216 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $163 | $200 | $259 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $179 | $254 | $425 |
| Office visit established patient minimal CPT 99211 • Office Visits | $17 | $23 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $34 | $64 | $109 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $82 | $128 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $130 | $247 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $125 | $184 | $278 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $124 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $202 | $253 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $257 | $338 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $44 | $90 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $99 | $154 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $132 | $232 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $103 | $157 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $121 | $152 | $222 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $132 | $220 |
| Consultation office high complexity CPT 99245 • Office Visits | $254 | $317 | $411 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $601 | $1,016 | $1,430 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $37 | $69 | $101 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $2,086 | $3,043 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $531 | $531 | $531 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $1,298 | $2,818 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $482 | $755 | $1,301 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $226 | $499 | $772 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $715 | $1,318 | $1,922 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $716 | $1,403 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $118 | $237 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $1,547 | $3,065 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $619 | $1,331 |