| Psychotherapy 45 minutes CPT 90834 • Mental Health | $107 | $162 | $285 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $117 | $161 | $250 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $136 | $234 | $419 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $202 | $331 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $237 | $402 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $113 | $199 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $132 | $179 | $274 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $132 | $183 | $285 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $61 | $76 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $8 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $18 | $223 | $421 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $42 | $185 | $433 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $67 | $215 | $431 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $100 | $214 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $158 | $348 | $678 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $107 | $119 | $142 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $79 | $150 | $226 |
| EMG needle each extremity complete CPT 95886 • Neurology | $40 | $104 | $154 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $83 | $90 | $103 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $127 | $184 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $63 | $192 | $374 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $34 | $207 | $332 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $52 | $359 | $801 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $92 | $122 | $177 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $40 | $139 | $203 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $42 | $197 | $408 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $14 | $237 | $539 |
| Office visit established patient minimal CPT 99211 • Office Visits | $28 | $38 | $47 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $75 | $115 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $77 | $119 | $185 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $38 | $131 | $262 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $42 | $208 | $368 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $8 | $128 | $183 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $140 | $207 | $288 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $180 | $288 | $385 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $67 | $102 | $116 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $5 | $105 | $175 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $92 | $165 | $264 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $54 | $118 | $179 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $161 | $253 |
| Consultation office low complexity CPT 99243 • Office Visits | $35 | $109 | $251 |
| Consultation office high complexity CPT 99245 • Office Visits | $21 | $253 | $468 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $69 | $925 | $1,577 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $81 | $92 | $115 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $983 | $2,034 | $3,730 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $201 | $570 | $860 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $231 | $1,720 | $3,454 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $572 | $977 | $1,595 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $177 | $624 | $947 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $42 | $884 | $2,356 |