| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $118 | $194 | $269 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $127 | $289 | $452 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $246 | $356 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $177 | $305 | $433 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $66 | $140 | $214 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $87 | $191 | $295 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $121 | $214 | $308 |
| Group psychotherapy CPT 90853 • Mental Health | $51 | $67 | $82 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $14 | $14 | $14 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $362 | $362 | $362 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $100 | $197 | $372 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $371 | $371 | $371 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $964 | $964 | $964 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $1,314 | $1,314 | $1,314 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $88 | $120 | $152 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $62 | $144 | $244 |
| EMG needle each extremity complete CPT 95886 • Neurology | $293 | $293 | $293 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $88 | $113 | $138 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $165 | $165 | $165 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $316 | $316 | $316 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $863 | $863 | $863 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $85 | $121 | $158 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $36 | $140 | $245 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $196 | $296 | $365 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $36 | $259 | $482 |
| Office visit established patient minimal CPT 99211 • Office Visits | $27 | $36 | $46 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $36 | $71 | $112 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $36 | $98 | $179 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $12 | $101 | $254 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $36 | $196 | $357 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $183 | $183 | $183 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $287 | $287 | $287 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $217 | $294 | $383 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $109 | $109 | $109 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $175 | $175 | $175 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $163 | $213 | $263 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $126 | $152 | $178 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $116 | $175 | $252 |
| Consultation office low complexity CPT 99243 • Office Visits | $121 | $237 | $341 |
| Consultation office high complexity CPT 99245 • Office Visits | $182 | $324 | $467 |
| 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 | $1,174 | $2,359 | $3,544 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $204 | $472 | $740 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $3,281 | $3,281 | $3,281 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $507 | $1,011 | $1,516 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $304 | $602 | $899 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $744 | $1,491 | $2,238 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $543 | $1,088 | $1,634 |