| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $224 | $224 | $224 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $220 | $320 | $419 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $298 | $298 | $298 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $402 | $402 | $402 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $199 | $199 | $199 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $178 | $225 | $273 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $185 | $235 | $286 |
| Group psychotherapy CPT 90853 • Mental Health | $45 | $56 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $211 | $301 | $421 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $182 | $297 | $375 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $183 | $245 | $342 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $100 | $129 | $158 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $678 | $949 | $1,220 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $312 | $312 | $312 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $142 | $295 | $448 |
| EMG needle each extremity complete CPT 95886 • Neurology | $80 | $112 | $144 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $250 | $250 | $250 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $128 | $169 | $211 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $221 | $235 | $250 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $332 | $411 | $490 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $280 | $303 | $325 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $97 | $133 | $177 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $152 | $203 | $274 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $76 | $248 | $408 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $158 | $315 | $445 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $28 | $33 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $74 | $89 | $115 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $123 | $144 | $185 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $83 | $150 | $201 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $247 | $288 | $368 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $97 | $151 | $183 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $152 | $225 | $288 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $154 | $273 | $385 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $57 | $78 | $110 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $92 | $131 | $175 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $139 | $194 | $264 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $97 | $134 | $179 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $138 | $192 | $253 |
| Consultation office low complexity CPT 99243 • Office Visits | $114 | $182 | $251 |
| Consultation office high complexity CPT 99245 • Office Visits | $272 | $370 | $468 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $816 | $1,312 | $1,577 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $49 | $86 | $123 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,284 | $2,345 | $3,730 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $317 | $514 | $651 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,213 | $2,236 | $3,454 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $576 | $1,086 | $1,595 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $261 | $653 | $947 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $816 | $1,374 | $2,356 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $599 | $1,098 | $1,605 |