| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $106 | $208 | $344 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $151 | $212 | $380 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $63 | $98 | $168 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $102 | $157 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $68 | $116 | $224 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $75 | $132 | $218 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $93 | $184 | $335 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $92 | $172 | $286 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $96 | $203 | $349 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $57 | $86 | $167 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $137 | $246 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $77 | $158 | $255 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $42 | $60 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $8 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $153 | $280 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $150 | $235 | $320 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $262 | $262 | $262 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $514 | $841 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $379 | $688 | $997 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $126 | $127 | $128 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $95 | $149 | $203 |
| EMG needle each extremity complete CPT 95886 • Neurology | $111 | $111 | $111 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $95 | $95 | $95 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $47 | $105 | $163 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $147 | $147 | $147 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $261 | $261 | $261 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $457 | $457 | $457 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $72 | $103 | $160 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $153 | $227 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $176 | $278 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $131 | $245 | $441 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $36 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $56 | $61 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $56 | $102 | $158 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $61 | $147 | $230 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $121 | $178 | $239 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $170 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $103 | $235 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $128 | $303 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $70 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $83 | $133 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $93 | $183 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $130 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $179 | $238 |
| Consultation office straightforward CPT 99241 • Office Visits | $49 | $49 | $49 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $170 | $263 |
| Consultation office high complexity CPT 99245 • Office Visits | $178 | $386 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $758 | $1,038 | $1,317 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $26 | $69 | $111 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,848 | $2,848 | $2,848 |