| Psychotherapy 60 minutes CPT 90837 • Mental Health | $210 | $290 | $370 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $320 | $320 | $320 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $158 | $158 | $158 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $79 | $79 | $79 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $99 | $99 | $99 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $126 | $126 | $126 |
| Group psychotherapy CPT 90853 • Mental Health | $36 | $36 | $36 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $15 | $15 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $461 | $461 | $461 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $202 | $276 | $350 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $164 | $197 | $231 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $247 | $415 | $583 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $685 | $925 | $1,164 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $99 | $148 | $197 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $44 | $50 | $56 |
| EMG needle each extremity complete CPT 95886 • Neurology | $63 | $109 | $154 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $117 | $117 | $117 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $144 | $173 | $203 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $85 | $160 | $234 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $240 | $279 | $318 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $151 | $325 | $498 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $120 | $167 | $214 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $79 | $237 | $395 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $158 | $238 | $391 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $283 | $389 | $495 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $27 | $32 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $34 | $39 | $44 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $70 | $96 | $122 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $126 | $146 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $144 | $187 | $230 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $297 | $301 | $305 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $66 | $233 | $399 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $66 | $136 | $206 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $129 | $216 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $209 | $239 | $268 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $66 | $87 | $109 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $66 | $138 | $210 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $178 | $244 | $310 |
| Consultation office low complexity CPT 99243 • Office Visits | $113 | $158 | $204 |
| Consultation office high complexity CPT 99245 • Office Visits | $66 | $164 | $263 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,746 | $1,746 | $1,746 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $197 | $197 | $197 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,243 | $1,243 | $1,243 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $337 | $337 | $337 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,136 | $1,136 | $1,136 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,848 | $1,848 | $1,848 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $681 | $681 | $681 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,043 | $1,043 | $1,043 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,845 | $1,845 | $1,845 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $295 | $295 | $295 |