| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $137 | $137 | $137 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $66 | $66 | $66 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $108 | $108 | $108 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $118 | $118 | $118 |
| Group psychotherapy CPT 90853 • Mental Health | $55 | $55 | $55 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $0 | $0 | $0 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $12 | $12 | $12 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $56 | $56 | $56 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $69 | $69 | $69 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $200 | $200 | $200 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $94 | $94 | $94 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $50 | $50 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $81 | $81 | $81 |
| EMG needle each extremity complete CPT 95886 • Neurology | $59 | $59 | $59 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $19 | $19 | $19 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $23 | $23 | $23 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $79 | $79 | $79 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $92 | $92 | $92 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $148 | $148 | $148 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $39 | $39 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $113 | $113 | $113 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $129 | $129 | $129 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $150 | $150 | $150 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $20 | $20 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $44 | $44 | $44 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $61 | $61 | $61 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $136 | $136 | $136 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $143 | $143 | $143 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $12 | $12 | $12 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $112 | $112 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $158 | $158 | $158 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $92 | $92 | $92 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $69 | $69 | $69 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $82 | $82 | $82 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $44 | $44 | $44 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $116 | $116 | $116 |
| Consultation office low complexity CPT 99243 • Office Visits | $44 | $44 | $44 |
| Consultation office high complexity CPT 99245 • Office Visits | $12 | $12 | $12 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $397 | $397 | $397 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $5 | $5 | $5 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,429 | $1,429 | $1,429 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $187 | $187 | $187 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $134 | $134 | $134 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $466 | $466 | $466 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $144 | $144 | $144 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $91 | $91 | $91 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $331 | $331 | $331 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $17 | $17 | $17 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $216 | $216 | $216 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $443 | $443 | $443 |