| Interactive complexity add-on CPT 90785 • Mental Health | $4 | $9 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $150 | $175 | $200 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $152 | $164 | $177 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $73 | $77 | $82 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $76 | $91 | $106 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $121 | $141 | $161 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $101 | $110 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $93 | $93 | $93 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $161 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $177 | $177 | $177 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $76 | $79 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $92 | $109 | $125 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $118 | $138 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $44 | $44 | $44 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $136 | $136 | $136 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $145 | $145 | $145 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $144 | $144 | $144 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $366 | $382 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $449 | $449 | $449 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $115 | $115 | $115 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $166 | $166 | $166 |
| EMG needle each extremity complete CPT 95886 • Neurology | $101 | $101 | $101 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $92 | $92 | $92 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $115 | $115 | $115 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $181 | $181 | $181 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $294 | $294 | $294 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $78 | $84 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $111 | $111 | $111 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $113 | $196 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $246 | $246 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $49 | $52 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $77 | $93 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $12 | $86 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $150 | $150 | $150 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $147 | $147 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $147 | $147 | $147 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $153 | $182 | $210 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $94 | $94 | $94 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $94 | $94 | $94 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $108 | $108 | $108 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $94 | $94 | $94 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $8 | $60 | $111 |
| Consultation office low complexity CPT 99243 • Office Visits | $142 | $142 | $142 |
| Consultation office high complexity CPT 99245 • Office Visits | $175 | $204 | $233 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $612 | $612 | $612 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $53 | $53 | $53 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,600 | $1,600 | $1,600 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,487 | $1,487 | $1,487 |