| Psychotherapy 60 minutes CPT 90837 • Mental Health | $102 | $140 | $181 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $151 | $159 | $166 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $248 | $248 | $248 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $128 | $128 | $128 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $67 | $91 | $116 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $123 | $137 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $38 | $38 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $169 | $221 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $181 | $199 | $217 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $184 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $233 | $380 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $296 | $440 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $152 | $152 | $152 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $88 | $129 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $78 | $78 | $78 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $67 | $87 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $118 | $147 | $197 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $147 | $165 | $178 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $169 | $266 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $34 | $83 | $128 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $93 | $111 | $128 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $104 | $156 | $223 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $129 | $215 | $360 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $20 | $31 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $47 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $61 | $88 | $129 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $82 | $120 | $184 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $112 | $141 | $172 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $52 | $107 | $137 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $109 | $157 | $189 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $210 | $250 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $35 | $45 | $51 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $50 | $82 | $99 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $100 | $124 | $143 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $68 | $87 | $100 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $112 | $144 |
| Consultation office low complexity CPT 99243 • Office Visits | $82 | $137 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $247 | $292 | $338 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $782 | $782 | $782 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $87 | $87 | $87 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,560 | $1,560 | $1,560 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $422 | $422 | $422 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,428 | $1,428 | $1,428 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $759 | $759 | $759 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $550 | $550 | $550 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,307 | $1,307 | $1,307 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $729 | $830 | $931 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $209 | $209 | $209 |