| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $131 | $177 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $185 | $270 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $105 | $170 | $234 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $120 | $120 | $120 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $56 | $56 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $161 | $218 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $164 | $226 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $54 | $78 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $7 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $328 | $328 | $328 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $271 | $271 | $271 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $262 | $262 | $262 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $69 | $403 | $737 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $846 | $846 | $846 |
| EMG needle each extremity complete CPT 95886 • Neurology | $104 | $147 | $189 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $202 | $202 | $202 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $131 | $195 | $260 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $150 | $230 | $310 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $177 | $294 | $410 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $318 | $470 | $621 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $86 | $120 | $155 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $108 | $166 | $224 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $189 | $265 | $342 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $273 | $352 | $431 |
| Office visit established patient minimal CPT 99211 • Office Visits | $27 | $42 | $57 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $72 | $90 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $110 | $131 | $152 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $123 | $173 | $224 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $185 | $243 | $302 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $92 | $153 | $213 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $148 | $218 | $288 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $230 | $328 | $427 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $56 | $93 | $130 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $105 | $129 | $152 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $92 | $156 | $220 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $66 | $109 | $153 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $146 | $186 | $226 |
| Consultation office low complexity CPT 99243 • Office Visits | $287 | $287 | $287 |
| Consultation office high complexity CPT 99245 • Office Visits | $468 | $468 | $468 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,262 | $1,262 | $1,262 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $143 | $143 | $143 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,480 | $2,480 | $2,480 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $548 | $548 | $548 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,283 | $2,283 | $2,283 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $645 | $645 | $645 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,664 | $1,664 | $1,664 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,337 | $1,337 | $1,337 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $351 | $351 | $351 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $2,515 | $2,515 | $2,515 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,080 | $1,080 | $1,080 |