| Psychotherapy 60 minutes CPT 90837 • Mental Health | $79 | $127 | $197 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $172 | $172 | $172 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $124 | $172 | $206 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $98 | $98 | $98 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $92 | $114 | $158 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $69 | $109 | $165 |
| Group psychotherapy CPT 90853 • Mental Health | $35 | $37 | $40 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $6 | $9 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $67 | $142 | $228 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $215 | $215 | $215 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $168 | $219 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $45 | $268 | $564 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $92 | $269 | $501 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $110 | $110 | $110 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $273 | $273 | $273 |
| EMG needle each extremity complete CPT 95886 • Neurology | $33 | $49 | $73 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $153 | $153 | $153 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $106 | $106 | $106 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $52 | $127 | $234 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $120 | $153 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $157 | $297 | $467 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $106 | $110 | $118 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $81 | $136 | $172 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $40 | $125 | $208 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $160 | $221 | $328 |
| Office visit established patient minimal CPT 99211 • Office Visits | $16 | $25 | $32 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $41 | $55 | $62 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $81 | $96 | $103 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $152 | $158 | $169 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $205 | $213 | $228 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $146 | $152 | $163 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $109 | $175 | $218 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $160 | $257 | $322 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $32 | $53 | $65 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $103 | $107 | $114 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $149 | $154 | $165 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $103 | $107 | $114 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $67 | $104 | $170 |
| Consultation office low complexity CPT 99243 • Office Visits | $83 | $127 | $192 |
| Consultation office high complexity CPT 99245 • Office Visits | $163 | $213 | $300 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $864 | $864 | $864 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $84 | $84 | $84 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,875 | $1,875 | $1,875 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $386 | $386 | $386 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,729 | $1,729 | $1,729 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,015 | $1,015 | $1,015 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $465 | $465 | $465 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,258 | $1,258 | $1,258 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,012 | $1,012 | $1,012 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $159 | $159 | $159 |