| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $104 | $160 | $199 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $128 | $218 | $304 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $147 | $168 | $210 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $134 | $185 | $255 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $88 | $123 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $137 | $180 | $217 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $167 | $225 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $56 | $87 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $6 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $37 | $167 | $350 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $42 | $201 | $299 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $76 | $175 | $268 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $323 | $525 | $690 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $215 | $460 | $737 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $59 | $130 | $225 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $164 | $312 |
| EMG needle each extremity complete CPT 95886 • Neurology | $79 | $119 | $170 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $101 | $151 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $86 | $103 | $131 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $110 | $177 | $223 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $136 | $177 | $261 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $211 | $332 | $483 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $80 | $96 | $133 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $106 | $170 | $252 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $42 | $193 | $297 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $189 | $255 | $370 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $21 | $28 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $57 | $77 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $73 | $93 | $130 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $44 | $155 | $251 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $137 | $187 | $258 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $126 | $174 | $239 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $38 | $156 | $250 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $180 | $260 | $368 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $29 | $66 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $91 | $108 | $131 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $44 | $121 | $189 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $44 | $95 | $131 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $126 | $150 | $194 |
| Consultation office low complexity CPT 99243 • Office Visits | $42 | $113 | $178 |
| Consultation office high complexity CPT 99245 • Office Visits | $44 | $235 | $351 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $256 | $673 | $1,249 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $81 | $110 | $155 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,474 | $1,951 | $2,641 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $42 | $433 | $767 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,155 | $1,904 | $2,711 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $534 | $907 | $1,424 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $44 | $359 | $665 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $42 | $749 | $1,825 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $794 | $1,229 | $1,502 |