| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $78 | $135 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $138 | $211 | $303 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $106 | $197 | $278 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $317 | $336 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $107 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $140 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $78 | $175 | $257 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $52 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $165 | $259 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $115 | $274 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $117 | $237 | $318 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $405 | $851 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $113 | $145 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $97 | $111 | $126 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $138 | $229 | $411 |
| EMG needle each extremity complete CPT 95886 • Neurology | $117 | $124 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $77 | $155 | $233 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $94 | $104 | $120 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $114 | $147 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $157 | $225 | $261 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $237 | $309 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $97 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $138 | $162 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $184 | $284 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $175 | $269 | $441 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $30 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $39 | $60 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $66 | $100 | $158 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $90 | $143 | $230 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $228 | $310 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $146 | $173 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $234 | $295 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $146 | $254 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $54 | $87 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $64 | $115 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $95 | $148 | $224 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $64 | $112 | $156 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $158 | $229 |
| Consultation office low complexity CPT 99243 • Office Visits | $124 | $161 | $194 |
| Consultation office high complexity CPT 99245 • Office Visits | $185 | $313 | $445 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,678 | $1,678 | $1,678 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $179 | $179 | $179 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $2,490 | $3,851 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $1,118 | $1,118 | $1,118 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $850 | $2,402 | $3,954 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $393 | $1,235 | $2,076 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $970 | $970 | $970 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $1,345 | $2,661 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $423 | $1,096 | $2,135 |