| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $191 | $429 | $666 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $52 | $134 | $258 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $102 | $157 | $212 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $130 | $235 | $341 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $116 | $207 | $299 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $99 | $300 | $501 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $252 | $395 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $481 | $481 | $481 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $96 | $167 | $238 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $238 | $326 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $150 | $246 | $341 |
| Group psychotherapy CPT 90853 • Mental Health | $91 | $91 | $91 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $9 | $15 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $279 | $469 | $581 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $245 | $581 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $74 | $254 | $581 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $189 | $305 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $1,459 | $1,459 | $1,459 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $224 | $337 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $202 | $244 |
| EMG needle each extremity complete CPT 95886 • Neurology | $173 | $173 | $173 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $80 | $123 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $112 | $155 | $198 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $134 | $199 | $264 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $352 | $528 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $285 | $310 | $335 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $84 | $110 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $112 | $150 | $189 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $232 | $365 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $143 | $257 | $413 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $32 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $74 | $114 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $85 | $179 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $106 | $198 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $168 | $229 | $291 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $110 | $189 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $200 | $287 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $149 | $231 | $383 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $79 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $91 | $175 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $134 | $263 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $107 | $184 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $165 | $261 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $117 | $203 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $369 | $484 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $525 | $855 | $1,601 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $321 | $581 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $581 | $1,207 | $2,460 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $154 | $341 | $581 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $839 | $1,738 |