| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $107 | $151 | $195 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $180 | $261 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $123 | $189 | $256 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $139 | $206 | $273 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $69 | $106 | $144 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $106 | $159 | $212 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $111 | $165 | $219 |
| Group psychotherapy CPT 90853 • Mental Health | $44 | $51 | $57 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $7 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $358 | $358 | $358 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $166 | $229 | $292 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $239 | $239 | $239 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $59 | $515 | $790 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $832 | $836 | $839 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $121 | $189 | $223 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $35 | $233 | $341 |
| EMG needle each extremity complete CPT 95886 • Neurology | $191 | $198 | $205 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $124 | $152 | $179 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $61 | $177 | $242 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $153 | $243 | $334 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $355 | $369 | $382 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $391 | $483 | $574 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $87 | $128 | $169 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $40 | $108 | $176 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $13 | $128 | $249 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $40 | $214 | $388 |
| Office visit established patient minimal CPT 99211 • Office Visits | $24 | $34 | $45 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $69 | $98 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $40 | $102 | $165 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $40 | $137 | $245 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $40 | $106 | $172 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $127 | $142 | $156 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $164 | $188 | $212 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $242 | $306 | $364 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $61 | $66 | $72 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $86 | $99 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $124 | $182 | $241 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $86 | $127 | $168 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $128 | $168 | $247 |
| Consultation office low complexity CPT 99243 • Office Visits | $132 | $142 | $150 |
| Consultation office high complexity CPT 99245 • Office Visits | $166 | $291 | $445 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,225 | $1,225 | $1,225 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $156 | $156 | $156 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,374 | $2,374 | $2,374 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $493 | $493 | $493 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,188 | $2,188 | $2,188 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $673 | $1,065 | $1,457 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $667 | $667 | $667 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,503 | $1,503 | $1,503 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $40 | $749 | $1,457 |