| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $77 | $77 | $77 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $128 | $198 | $254 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $114 | $114 | $114 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $123 | $123 | $123 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $68 | $68 | $68 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $94 | $94 | $94 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $98 | $98 | $98 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $26 | $26 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $72 | $464 | $595 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $95 | $484 | $977 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $83 | $481 | $977 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $307 | $307 | $307 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $419 | $419 | $419 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $59 | $59 | $59 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $78 | $78 | $78 |
| EMG needle each extremity complete CPT 95886 • Neurology | $50 | $50 | $50 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $51 | $51 | $51 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $107 | $107 | $107 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $53 | $53 | $53 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $101 | $101 | $101 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $96 | $96 | $96 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $95 | $113 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $85 | $134 | $174 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $204 | $261 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $275 | $333 | $367 |
| Office visit established patient minimal CPT 99211 • Office Visits | $29 | $33 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $60 | $76 | $87 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $65 | $116 | $142 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $160 | $197 | $214 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $219 | $282 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $104 | $146 | $167 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $114 | $175 | $211 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $159 | $250 | $311 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $60 | $61 | $63 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $69 | $98 | $112 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $98 | $142 | $161 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $102 | $110 | $116 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $144 | $165 |
| Consultation office low complexity CPT 99243 • Office Visits | $143 | $172 | $187 |
| Consultation office high complexity CPT 99245 • Office Visits | $266 | $286 | $296 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $633 | $947 | $1,171 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $44 | $744 | $977 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $977 | $1,355 | $2,500 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $281 | $803 | $977 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $977 | $1,125 | $1,450 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $576 | $991 | $1,450 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $215 | $468 | $595 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $977 | $1,079 | $1,450 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $977 | $1,079 | $1,450 |