| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $100 | $118 | $135 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $127 | $167 | $208 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $157 | $179 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $177 | $196 | $215 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $88 | $95 | $103 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $99 | $133 | $166 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $121 | $147 | $173 |
| Group psychotherapy CPT 90853 • Mental Health | $42 | $43 | $44 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $6 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $263 | $263 | $263 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $117 | $143 | $195 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $210 | $210 | $210 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $95 | $95 | $95 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $679 | $679 | $679 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $85 | $87 | $88 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $128 | $131 | $137 |
| EMG needle each extremity complete CPT 95886 • Neurology | $150 | $150 | $150 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $157 | $157 | $157 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $88 | $141 | $194 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $237 | $237 | $237 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $316 | $316 | $316 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $177 | $177 | $177 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $122 | $122 | $122 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $176 | $176 | $176 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $176 | $207 | $269 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $166 | $242 | $338 |
| Office visit established patient minimal CPT 99211 • Office Visits | $32 | $32 | $32 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $71 | $71 | $71 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $119 | $119 | $119 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $117 | $121 | $128 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $182 | $182 | $182 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $166 | $166 | $166 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $224 | $224 | $224 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $217 | $274 | $331 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $64 | $64 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $118 | $118 | $118 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $170 | $170 | $170 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $118 | $118 | $118 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $116 | $146 | $175 |
| Consultation office low complexity CPT 99243 • Office Visits | $121 | $139 | $157 |
| Consultation office high complexity CPT 99245 • Office Visits | $242 | $277 | $311 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $997 | $997 | $997 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $113 | $113 | $113 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,947 | $1,947 | $1,947 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $204 | $326 | $448 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,594 | $1,594 | $1,594 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $507 | $781 | $1,054 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $388 | $388 | $388 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,306 | $1,306 | $1,306 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,050 | $1,050 | $1,050 |