| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $116 | $150 | $185 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $258 | $258 | $258 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $176 | $243 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $269 | $269 | $269 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $96 | $112 | $129 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $180 | $209 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $183 | $216 |
| Group psychotherapy CPT 90853 • Mental Health | $56 | $56 | $57 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $10 | $10 | $10 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $283 | $345 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $151 | $272 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $178 | $222 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $367 | $482 | $597 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $729 | $729 | $729 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $121 | $132 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $252 | $343 |
| EMG needle each extremity complete CPT 95886 • Neurology | $194 | $194 | $194 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $81 | $85 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $80 | $138 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $213 | $291 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $161 | $168 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $221 | $253 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $109 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $138 | $196 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $237 | $310 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $216 | $315 | $420 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $41 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $88 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $124 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $117 | $196 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $263 | $338 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $148 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $251 | $279 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $198 | $339 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $72 | $80 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $108 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $151 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $109 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $188 | $238 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $141 | $217 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $388 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,253 | $1,253 | $1,253 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $76 | $76 | $76 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,421 | $2,421 | $2,421 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $504 | $504 | $504 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $1,131 | $2,233 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $753 | $1,023 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $609 | $609 | $609 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,533 | $1,533 | $1,533 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $573 | $1,117 |