| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $50 | $84 | $116 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $76 | $107 | $138 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $73 | $113 | $144 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $89 | $132 | $176 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $42 | $65 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $113 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $64 | $105 | $150 |
| Group psychotherapy CPT 90853 • Mental Health | $17 | $37 | $58 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $86 | $86 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $56 | $83 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $68 | $101 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $36 | $201 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $229 | $229 | $229 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $32 | $72 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $54 | $125 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $31 | $31 | $31 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $25 | $35 | $45 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $28 | $33 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $89 | $112 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $121 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $186 | $236 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $31 | $55 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $46 | $71 | $96 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $100 | $129 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $104 | $149 | $188 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $25 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $16 | $37 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $51 | $78 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $69 | $110 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $68 | $111 | $154 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $87 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $84 | $127 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $163 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $24 | $77 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $68 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $74 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $68 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $65 | $98 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $53 | $76 |
| Consultation office high complexity CPT 99245 • Office Visits | $118 | $186 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $337 | $337 | $337 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $23 | $23 | $23 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $724 | $724 | $724 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $151 | $151 | $151 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $350 | $670 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $308 | $395 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $107 | $184 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $459 | $459 | $459 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $182 | $335 |