| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $73 | $103 | $134 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $146 | $190 | $234 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $127 | $171 | $215 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $153 | $233 | $313 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $64 | $113 | $162 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $118 | $141 | $164 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $156 | $204 |
| Group psychotherapy CPT 90853 • Mental Health | $25 | $40 | $55 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $279 | $279 | $279 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $148 | $271 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $212 | $212 | $212 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $323 | $323 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $101 | $101 | $101 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $63 | $93 | $124 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $148 | $163 | $171 |
| EMG needle each extremity complete CPT 95886 • Neurology | $85 | $85 | $85 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $194 | $194 | $194 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $109 | $114 | $119 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $64 | $176 | $287 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $378 | $378 | $378 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $620 | $620 | $620 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $85 | $85 | $85 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $176 | $176 | $176 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $143 | $270 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $180 | $340 |
| Office visit established patient minimal CPT 99211 • Office Visits | $36 | $36 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $44 | $44 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $117 | $117 | $117 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $99 | $125 | $176 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $185 | $185 | $185 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $169 | $169 | $169 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $231 | $231 | $231 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $149 | $244 | $339 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $70 | $70 | $70 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $125 | $125 | $125 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $180 | $180 | $180 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $125 | $125 | $125 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $80 | $131 | $182 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $120 | $239 |
| Consultation office high complexity CPT 99245 • Office Visits | $167 | $299 | $431 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,034 | $1,034 | $1,034 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $87 | $87 | $87 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,102 | $1,494 | $1,886 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $545 | $545 | $545 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,878 | $1,878 | $1,878 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $601 | $802 | $1,002 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $716 | $716 | $716 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,697 | $1,697 | $1,697 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,217 | $1,217 | $1,217 |