| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $102 | $144 | $233 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $184 | $346 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $104 | $172 | $308 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $375 | $375 | $375 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $138 | $138 | $138 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $100 | $152 | $255 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $98 | $156 | $266 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $34 | $46 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $7 | $12 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $41 | $142 | $344 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $41 | $148 | $353 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $112 | $129 | $180 |
| 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 | $159 | $159 | $159 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $75 | $188 | $417 |
| 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 | $126 | $291 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $188 | $349 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $176 | $246 | $457 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $288 | $337 | $485 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $41 | $75 | $139 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $41 | $100 | $160 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $41 | $138 | $228 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $41 | $235 | $351 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $29 | $41 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $40 | $49 | $76 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $41 | $75 | $128 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $41 | $130 | $247 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $41 | $181 | $346 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $41 | $71 | $161 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $41 | $112 | $253 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $41 | $160 | $338 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $41 | $59 | $96 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $41 | $79 | $154 |
| 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 | $70 | $157 |
| 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 | $153 | $318 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $41 | $565 | $1,614 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $41 | $56 | $87 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $992 | $1,156 | $1,484 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $41 | $277 | $493 |
| 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 | $202 | $523 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $41 | $958 | $1,922 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $41 | $536 | $1,403 |