| Psychotherapy 60 minutes CPT 90837 • Mental Health | $71 | $187 | $303 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $88 | $175 | $262 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $317 | $317 | $317 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $167 | $167 | $167 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $246 | $246 | $246 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $70 | $162 | $255 |
| Group psychotherapy CPT 90853 • Mental Health | $60 | $62 | $63 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $9 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $85 | $275 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $183 | $252 | $320 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $318 | $318 | $318 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $565 | $703 | $841 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $997 | $997 | $997 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $155 | $155 | $155 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $403 | $403 | $403 |
| EMG needle each extremity complete CPT 95886 • Neurology | $117 | $128 | $138 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $130 | $130 | $130 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $286 | $286 | $286 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $147 | $147 | $147 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $190 | $223 | $257 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $418 | $437 | $457 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $100 | $142 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $156 | $213 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $158 | $296 | $381 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $215 | $359 | $441 |
| Office visit established patient minimal CPT 99211 • Office Visits | $30 | $43 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $79 | $101 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $78 | $148 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $87 | $130 | $230 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $235 | $319 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $100 | $182 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $158 | $253 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $211 | $365 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $60 | $77 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $103 | $140 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $145 | $200 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $101 | $140 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $144 | $204 | $238 |
| Consultation office low complexity CPT 99243 • Office Visits | $263 | $268 | $273 |
| Consultation office high complexity CPT 99245 • Office Visits | $482 | $490 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,474 | $1,474 | $1,474 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $111 | $111 | $111 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,848 | $2,848 | $2,848 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $500 | $500 | $500 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,627 | $2,627 | $2,627 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,204 | $1,204 | $1,204 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $716 | $716 | $716 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,803 | $1,803 | $1,803 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,314 | $1,314 | $1,314 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $238 | $238 | $238 |