| Interactive complexity add-on CPT 90785 • Mental Health | $3 | $7 | $11 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $125 | $169 | $191 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $154 | $159 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $82 | $89 | $93 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $72 | $93 | $106 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $71 | $98 | $130 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $71 | $96 | $119 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $177 | $187 | $196 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $94 | $129 | $185 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $114 | $139 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $67 | $78 | $96 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $95 | $132 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $123 | $143 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $44 | $76 | $108 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $133 | $133 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $359 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $429 | $429 | $429 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $97 | $97 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $111 | $111 | $112 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $106 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $285 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $84 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $107 | $118 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $133 | $144 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $178 | $212 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $26 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $56 | $59 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $79 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $107 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $173 | $174 | $175 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $108 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $124 | $127 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $214 | $246 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $47 | $79 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $70 | $116 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $81 | $113 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $76 | $110 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $116 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $71 | $92 |
| Consultation office high complexity CPT 99245 • Office Visits | $202 | $237 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $30 | $30 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $30 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $30 | $30 | $30 |