| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $76 | $115 | $154 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $137 | $186 | $235 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $157 | $196 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $194 | $245 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $68 | $87 | $106 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $93 | $130 | $167 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $114 | $144 | $174 |
| Group psychotherapy CPT 90853 • Mental Health | $46 | $53 | $60 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $11 | $11 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $222 | $314 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $141 | $237 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $318 | $318 | $318 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $841 | $841 | $841 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $140 | $140 | $140 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $94 | $124 | $155 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $134 | $186 | $291 |
| EMG needle each extremity complete CPT 95886 • Neurology | $80 | $80 | $80 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $89 | $89 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $97 | $192 | $286 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $195 | $195 | $195 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $130 | $130 | $130 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $323 | $323 | $323 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $85 | $125 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $122 | $189 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $179 | $278 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $162 | $255 | $441 |
| Office visit established patient minimal CPT 99211 • Office Visits | $39 | $45 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $95 | $112 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $110 | $158 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $95 | $124 | $183 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $246 | $329 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $218 | $223 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $295 | $301 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $214 | $335 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $64 | $76 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $117 | $139 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $168 | $201 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $117 | $140 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $96 | $188 | $238 |
| Consultation office low complexity CPT 99243 • Office Visits | $86 | $117 | $157 |
| Consultation office high complexity CPT 99245 • Office Visits | $45 | $302 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $45 | $512 | $979 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $63 | $81 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,848 | $2,848 | $2,848 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $45 | $189 | $332 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $45 | $895 | $1,744 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $374 | $630 | $886 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $45 | $287 | $529 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,321 | $1,321 | $1,321 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $45 | $459 | $873 |