| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $130 | $184 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $112 | $210 | $308 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $128 | $196 | $263 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $156 | $239 | $321 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $105 | $154 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $79 | $152 | $225 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $109 | $172 | $234 |
| Group psychotherapy CPT 90853 • Mental Health | $41 | $48 | $55 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $10 | $10 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $116 | $127 | $139 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $124 | $207 | $290 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $126 | $208 | $291 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $352 | $563 | $774 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $412 | $601 | $790 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $106 | $118 | $143 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $154 | $165 | $187 |
| EMG needle each extremity complete CPT 95886 • Neurology | $93 | $151 | $210 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $85 | $146 | $207 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $121 | $150 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $53 | $184 | $315 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $168 | $204 | $240 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $272 | $466 | $660 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $106 | $106 | $106 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $108 | $165 | $222 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $107 | $223 | $340 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $213 | $430 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $19 | $19 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $51 | $93 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $75 | $115 | $154 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $110 | $129 | $165 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $148 | $225 | $302 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $214 | $214 | $214 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $289 | $289 | $289 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $16 | $220 | $424 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $82 | $82 | $82 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $151 | $151 | $151 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $218 | $218 | $218 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $152 | $152 | $152 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $147 | $223 |
| Consultation office low complexity CPT 99243 • Office Visits | $131 | $155 | $203 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $241 | $470 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $534 | $929 | $1,323 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $38 | $69 | $99 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,556 | $2,556 | $2,556 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $532 | $532 | $532 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,056 | $1,706 | $2,357 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $486 | $684 | $1,080 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $643 | $643 | $643 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,618 | $1,618 | $1,618 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,179 | $1,179 | $1,179 |