| Psychotherapy 60 minutes CPT 90837 • Mental Health | $131 | $291 | $452 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $151 | $253 | $356 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $433 | $433 | $433 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $214 | $214 | $214 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $105 | $200 | $295 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $208 | $308 |
| Group psychotherapy CPT 90853 • Mental Health | $38 | $60 | $82 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $8 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $70 | $216 | $362 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $181 | $277 | $372 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $264 | $318 | $371 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $80 | $159 | $194 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $80 | $155 | $216 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $152 | $152 | $152 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $482 | $482 | $482 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $172 | $293 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $60 | $121 | $198 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $77 | $118 | $165 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $103 | $189 | $316 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $292 | $522 | $863 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $75 | $111 | $158 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $84 | $150 | $245 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $33 | $229 | $365 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $202 | $349 | $482 |
| Office visit established patient minimal CPT 99211 • Office Visits | $12 | $30 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $67 | $112 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $62 | $123 | $179 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $33 | $133 | $254 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $142 | $232 | $357 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $85 | $136 | $183 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $140 | $205 | $287 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $191 | $249 | $383 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $69 | $109 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $114 | $175 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $97 | $168 | $263 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $82 | $119 | $178 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $109 | $153 | $252 |
| Consultation office low complexity CPT 99243 • Office Visits | $133 | $241 | $341 |
| Consultation office high complexity CPT 99245 • Office Visits | $338 | $476 | $624 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,738 | $1,738 | $1,738 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $117 | $117 | $117 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $3,544 | $3,544 | $3,544 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $740 | $740 | $740 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $3,281 | $3,281 | $3,281 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,516 | $1,516 | $1,516 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $899 | $899 | $899 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $2,238 | $2,238 | $2,238 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $729 | $1,181 | $1,634 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $342 | $342 | $342 |