| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $132 | $196 | $249 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $56 | $81 | $119 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $20 | $68 | $113 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $55 | $105 | $154 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $40 | $103 | $143 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $117 | $200 | $304 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $70 | $159 | $208 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $109 | $240 | $310 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $116 | $161 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $55 | $107 | $145 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $55 | $127 | $180 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $50 | $84 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $75 | $172 | $250 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $82 | $200 | $304 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $95 | $169 | $214 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $300 | $421 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $58 | $333 | $470 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $71 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $60 | $114 | $190 |
| EMG needle each extremity complete CPT 95886 • Neurology | $35 | $76 | $148 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $49 | $106 | $175 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $171 | $216 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $74 | $150 | $223 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $70 | $193 | $293 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $176 | $379 | $561 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $94 | $103 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $73 | $124 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $181 | $229 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $154 | $238 | $292 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $22 | $33 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $51 | $62 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $41 | $77 | $100 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $71 | $121 | $151 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $95 | $168 | $204 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $125 | $174 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $161 | $198 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $147 | $228 | $292 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $47 | $60 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $99 | $156 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $129 | $156 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $64 | $103 | $156 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $94 | $134 | $157 |
| Consultation office low complexity CPT 99243 • Office Visits | $73 | $158 | $203 |
| Consultation office high complexity CPT 99245 • Office Visits | $142 | $275 | $370 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $388 | $775 | $966 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $30 | $59 | $98 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $663 | $1,439 | $1,907 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $264 | $392 | $477 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $648 | $1,331 | $1,764 |