| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $165 | $165 | $165 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $128 | $128 | $128 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $113 | $113 | $113 |
| Group psychotherapy CPT 90853 • Mental Health | $78 | $78 | $78 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $1 | $1 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $12 | $12 | $12 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $99 | $99 | $99 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $74 | $74 | $74 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $73 | $73 | $73 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $80 | $80 |
| EMG needle each extremity complete CPT 95886 • Neurology | $22 | $22 | $22 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $56 | $56 | $56 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $105 | $105 | $105 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $101 | $101 | $101 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $68 | $68 | $68 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $82 | $82 | $82 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $139 | $139 | $139 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $162 | $162 | $162 |
| Office visit established patient minimal CPT 99211 • Office Visits | $3 | $3 | $3 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $43 | $43 | $43 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $44 | $44 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $96 | $96 | $96 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $71 | $71 | $71 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $128 | $128 | $128 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $66 | $66 | $66 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $149 | $149 | $149 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $97 | $97 | $97 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $69 | $69 | $69 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $100 | $100 | $100 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $65 | $65 | $65 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $10 | $10 | $10 |
| Consultation office low complexity CPT 99243 • Office Visits | $14 | $14 | $14 |
| Consultation office high complexity CPT 99245 • Office Visits | $191 | $191 | $191 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $266 | $266 | $266 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $35 | $35 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $848 | $848 | $848 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $99 | $99 | $99 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $157 | $157 | $157 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $458 | $458 | $458 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $21 | $21 | $21 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $143 | $143 | $143 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $104 | $104 | $104 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $103 | $103 | $103 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $288 | $288 | $288 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $21 | $21 | $21 |