| Interactive complexity add-on CPT 90785 • Mental Health | $15 | $15 | $15 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $120 | $141 | $162 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $164 | $172 | $180 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $72 | $72 | $72 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $105 | $105 | $105 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $157 | $157 | $157 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $142 | $142 | $142 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $164 | $164 | $164 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $58 | $58 | $58 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $150 | $150 | $150 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $123 | $123 | $123 |
| Group psychotherapy CPT 90853 • Mental Health | $46 | $46 | $46 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $296 | $296 | $296 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $110 | $110 | $110 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $320 | $320 | $320 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $678 | $678 | $678 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $794 | $794 | $794 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $156 | $209 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $148 | $148 | $148 |
| EMG needle each extremity complete CPT 95886 • Neurology | $184 | $184 | $184 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $170 | $170 | $170 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $108 | $160 | $212 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $78 | $78 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $334 | $334 | $334 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $544 | $544 | $544 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $77 | $77 | $77 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $111 | $111 | $111 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $106 | $139 | $172 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $123 | $217 |
| Office visit established patient minimal CPT 99211 • Office Visits | $48 | $48 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $51 | $51 | $51 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $79 | $79 | $79 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $111 | $111 | $111 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $159 | $159 | $159 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $175 | $175 | $175 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $175 | $175 | $175 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $166 | $192 | $217 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $92 | $92 | $92 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $92 | $92 | $92 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $111 | $111 | $111 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $92 | $92 | $92 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $113 | $113 | $113 |
| Consultation office low complexity CPT 99243 • Office Visits | $92 | $109 | $127 |
| Consultation office high complexity CPT 99245 • Office Visits | $232 | $251 | $270 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $871 | $871 | $871 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $92 | $92 | $92 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,521 | $2,521 | $2,521 |