| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $61 | $130 | $199 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $217 | $335 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $197 | $286 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $130 | $223 | $317 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $112 | $167 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $65 | $156 | $246 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $172 | $255 |
| Group psychotherapy CPT 90853 • Mental Health | $60 | $62 | $64 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $11 | $11 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $333 | $370 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $143 | $232 | $320 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $143 | $230 | $318 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $139 | $264 | $390 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $140 | $296 | $453 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $168 | $281 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $240 | $403 |
| EMG needle each extremity complete CPT 95886 • Neurology | $96 | $162 | $228 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $109 | $130 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $109 | $127 | $163 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $342 | $342 | $342 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $171 | $311 | $450 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $278 | $367 | $457 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $108 | $137 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $227 | $241 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $165 | $257 | $348 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $212 | $326 | $441 |
| Office visit established patient minimal CPT 99211 • Office Visits | $48 | $50 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $92 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $110 | $158 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $108 | $128 | $170 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $310 | $361 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $218 | $223 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $295 | $301 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $164 | $349 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $84 | $86 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $155 | $159 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $224 | $228 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $156 | $160 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $192 | $238 |
| Consultation office low complexity CPT 99243 • Office Visits | $129 | $174 | $263 |
| Consultation office high complexity CPT 99245 • Office Visits | $238 | $406 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $560 | $939 | $1,317 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $79 | $111 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,482 | $2,165 | $2,848 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $593 | $593 | $593 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,386 | $2,006 | $2,627 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $647 | $833 | $1,204 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $716 | $716 | $716 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $939 | $1,371 | $1,803 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $686 | $1,000 | $1,314 |