| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $126 | $152 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $121 | $121 | $121 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $146 | $146 | $146 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $73 | $73 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $98 | $98 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $102 | $102 |
| Group psychotherapy CPT 90853 • Mental Health | $28 | $28 | $28 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $146 | $146 | $146 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $120 | $120 | $120 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $139 | $139 | $139 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $56 | $56 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $50 | $50 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $79 | $79 | $79 |
| EMG needle each extremity complete CPT 95886 • Neurology | $52 | $52 | $52 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $134 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $103 | $103 | $103 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $69 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $85 | $98 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $151 | $169 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $205 | $213 | $220 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $56 | $57 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $75 | $85 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $128 | $136 | $142 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $133 | $157 | $180 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $79 | $82 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $121 | $125 | $129 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $166 | $171 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $47 | $49 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $58 | $68 | $78 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $110 | $117 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $78 | $80 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $110 | $113 |
| Consultation office low complexity CPT 99243 • Office Visits | $112 | $112 | $112 |
| Consultation office high complexity CPT 99245 • Office Visits | $209 | $209 | $209 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $934 | $934 | $934 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $38 | $38 | $38 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,165 | $1,165 | $1,165 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $233 | $238 | $243 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,083 | $1,083 | $1,083 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $503 | $503 | $503 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $297 | $297 | $297 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $736 | $736 | $736 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $323 | $430 | $537 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $103 | $108 | $112 |