| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $160 | $211 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $93 | $186 | $324 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $151 | $229 | $277 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $298 | $318 | $339 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $95 | $135 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $172 | $261 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $110 | $225 | $269 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $50 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $8 | $10 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $165 | $259 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $191 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $267 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $363 | $706 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $474 | $971 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $64 | $97 | $130 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $82 | $153 | $208 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $111 | $224 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $64 | $134 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $23 | $118 | $167 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $112 | $149 | $200 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $150 | $260 | $454 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $190 | $341 | $476 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $97 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $155 | $210 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $16 | $175 | $323 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $143 | $232 | $334 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $32 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $35 | $58 | $84 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $87 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $96 | $148 | $210 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $218 | $281 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $135 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $210 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $149 | $255 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $53 | $87 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $100 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $127 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $107 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $130 | $162 | $211 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $135 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $184 | $322 | $445 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,678 | $1,678 | $1,678 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $226 | $226 | $226 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,478 | $2,664 | $3,851 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $197 | $657 | $1,118 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $1,992 | $3,954 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $1,279 | $2,076 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $970 | $970 | $970 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $935 | $1,798 | $2,661 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $894 | $2,135 |