| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $167 | $218 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $184 | $259 | $335 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $144 | $215 | $286 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $176 | $263 | $349 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $124 | $167 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $197 | $244 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $202 | $254 |
| Group psychotherapy CPT 90853 • Mental Health | $60 | $63 | $66 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $11 | $11 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $333 | $333 | $333 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $132 | $226 | $320 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $318 | $318 | $318 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $702 | $702 | $702 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $140 | $140 | $140 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $196 | $281 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $175 | $203 |
| EMG needle each extremity complete CPT 95886 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $225 | $225 | $225 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $73 | $123 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $342 | $342 | $342 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $190 | $190 | $190 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $457 | $457 | $457 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $89 | $108 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $168 | $227 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $162 | $225 | $348 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $215 | $264 | $363 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $39 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $56 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $88 | $123 | $158 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $125 | $160 | $230 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $208 | $239 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $170 | $194 | $218 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $233 | $295 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $277 | $434 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $84 | $107 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $129 | $142 | $155 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $129 | $176 | $224 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $129 | $143 | $156 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $179 | $229 |
| Consultation office low complexity CPT 99243 • Office Visits | $127 | $187 | $263 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $335 | $414 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,474 | $1,474 | $1,474 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $89 | $89 | $89 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,989 | $2,848 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $593 | $593 | $593 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,627 | $2,627 | $2,627 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $843 | $1,204 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $567 | $567 | $567 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,803 | $1,803 | $1,803 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,314 | $1,314 | $1,314 |