| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $90 | $135 | $209 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $184 | $346 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $138 | $181 | $308 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $266 | $266 | $266 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $185 | $185 | $185 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $100 | $151 | $254 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $98 | $156 | $266 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $40 | $71 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $8 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $41 | $103 | $226 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $107 | $306 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $112 | $172 | $352 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $303 | $472 | $981 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $51 | $413 | $1,137 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $291 | $291 | $291 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $130 | $149 | $206 |
| EMG needle each extremity complete CPT 95886 • Neurology | $84 | $95 | $118 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $96 | $96 | $96 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $51 | $83 | $119 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $72 | $172 | $349 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $176 | $178 | $183 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $288 | $337 | $485 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $41 | $67 | $97 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $41 | $107 | $160 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $41 | $154 | $322 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $41 | $235 | $351 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $34 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $34 | $57 | $109 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $41 | $73 | $128 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $41 | $108 | $247 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $41 | $171 | $278 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $41 | $55 | $97 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $41 | $81 | $162 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $41 | $146 | $338 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $41 | $44 | $49 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $41 | $60 | $80 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $41 | $59 | $114 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $41 | $56 | $102 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $91 | $128 | $222 |
| Consultation office low complexity CPT 99243 • Office Visits | $41 | $121 | $220 |
| Consultation office high complexity CPT 99245 • Office Visits | $41 | $134 | $411 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $41 | $565 | $1,614 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $41 | $61 | $101 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $992 | $1,156 | $1,484 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $41 | $277 | $531 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $41 | $368 | $1,349 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $717 | $717 | $717 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $41 | $298 | $609 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $41 | $958 | $1,922 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $41 | $381 | $1,403 |