| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $144 | $209 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $102 | $200 | $322 |
| 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 | $49 | $120 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $67 | $163 | $263 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $225 | $271 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $42 | $65 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $9 | $13 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $228 | $511 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $111 | $273 | $436 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $107 | $254 | $390 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $193 | $353 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $438 | $826 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $102 | $124 | $165 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $143 | $232 | $411 |
| EMG needle each extremity complete CPT 95886 • Neurology | $92 | $110 | $131 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $85 | $110 | $134 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $135 | $167 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $77 | $111 | $145 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $167 | $231 | $267 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $275 | $322 | $412 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $97 | $144 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $94 | $130 | $151 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $116 | $199 | $258 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $191 | $318 | $403 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $29 | $39 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $47 | $53 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $76 | $88 | $101 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $17 | $83 | $156 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $152 | $195 | $281 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $71 | $136 | $200 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $191 | $272 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $150 | $244 | $401 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $63 | $78 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $103 | $143 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $162 | $205 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $69 | $112 | $143 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $98 | $139 | $211 |
| Consultation office low complexity CPT 99243 • Office Visits | $54 | $155 | $244 |
| Consultation office high complexity CPT 99245 • Office Visits | $30 | $233 | $445 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $507 | $1,092 | $1,678 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $39 | $133 | $226 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,206 | $2,528 | $3,851 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $1,118 | $1,118 | $1,118 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,112 | $2,533 | $3,954 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $511 | $1,034 | $2,076 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $970 | $970 | $970 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $2,661 | $2,661 | $2,661 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $729 | $1,432 | $2,135 |