| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $140 | $225 | $330 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $76 | $111 | $166 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $53 | $96 | $134 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $110 | $157 | $237 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $81 | $123 | $189 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $131 | $180 | $289 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $106 | $168 | $289 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $371 | $371 | $371 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $72 | $143 | $214 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $223 | $295 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $214 | $278 |
| Group psychotherapy CPT 90853 • Mental Health | $58 | $58 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $85 | $358 | $903 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $209 | $385 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $234 | $360 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $207 | $768 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $430 | $558 | $929 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $148 | $184 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $35 | $131 | $226 |
| EMG needle each extremity complete CPT 95886 • Neurology | $84 | $142 | $217 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $93 | $142 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $133 | $227 | $321 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $223 | $383 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $105 | $182 | $257 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $281 | $317 | $418 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $50 | $99 | $147 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $86 | $153 | $209 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $13 | $198 | $365 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $263 | $400 |
| Office visit established patient minimal CPT 99211 • Office Visits | $3 | $29 | $56 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $51 | $66 | $87 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $99 | $143 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $19 | $132 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $140 | $219 | $282 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $135 | $198 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $101 | $192 | $287 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $96 | $248 | $396 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $58 | $71 | $103 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $96 | $167 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $50 | $145 | $263 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $100 | $170 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $150 | $209 |
| Consultation office low complexity CPT 99243 • Office Visits | $141 | $192 | $292 |
| Consultation office high complexity CPT 99245 • Office Visits | $45 | $280 | $374 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $676 | $1,135 | $1,725 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $5 | $135 | $360 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,849 | $2,872 | $6,029 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $218 | $496 | $903 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $2,040 | $3,920 |