| Psychotherapy 60 minutes CPT 90837 • Mental Health | $128 | $194 | $260 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $138 | $171 | $204 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $272 | $272 | $272 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $130 | $130 | $130 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $137 | $164 | $191 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $152 | $198 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $39 | $52 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $8 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $97 | $211 | $326 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $247 | $261 | $275 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $202 | $256 | $310 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $73 | $309 | $546 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $73 | $370 | $667 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $120 | $120 | $120 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $155 | $155 | $155 |
| EMG needle each extremity complete CPT 95886 • Neurology | $86 | $101 | $116 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $68 | $121 | $175 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $153 | $188 | $222 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $151 | $167 | $183 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $203 | $221 | $240 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $202 | $289 | $375 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $63 | $101 | $138 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $80 | $110 | $140 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $203 | $252 | $301 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $210 | $261 | $313 |
| Office visit established patient minimal CPT 99211 • Office Visits | $28 | $35 | $42 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $48 | $51 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $85 | $111 | $137 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $134 | $140 | $146 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $138 | $203 | $267 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $126 | $157 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $170 | $213 | $255 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $252 | $314 | $375 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $49 | $61 | $73 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $91 | $112 | $134 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $130 | $162 | $193 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $91 | $113 | $135 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $133 | $166 | $198 |
| Consultation office low complexity CPT 99243 • Office Visits | $120 | $174 | $227 |
| Consultation office high complexity CPT 99245 • Office Visits | $278 | $347 | $416 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,441 | $1,441 | $1,441 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $87 | $87 | $87 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,474 | $2,129 | $2,783 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $579 | $579 | $579 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,567 | $2,567 | $2,567 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,177 | $1,177 | $1,177 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $293 | $424 | $554 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $988 | $1,375 | $1,762 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $794 | $1,039 | $1,284 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $190 | $214 | $238 |