| Psychotherapy 30 minutes CPT 90832 • Mental Health | $75 | $75 | $75 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $81 | $81 | $81 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $108 | $108 | $108 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $101 | $101 | $101 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $105 | $105 | $105 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $136 | $136 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $146 | $146 | $146 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $54 | $54 | $54 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $108 | $108 | $108 |
| Group psychotherapy CPT 90853 • Mental Health | $44 | $44 | $44 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $48 | $48 | $48 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $15 | $15 | $15 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $317 | $317 | $317 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $122 | $122 | $122 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $177 | $177 | $177 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $124 | $124 | $124 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $148 | $148 | $148 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $48 | $48 | $48 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $117 | $137 | $157 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $168 | $183 | $199 |
| Office visit established patient minimal CPT 99211 • Office Visits | $48 | $48 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $48 | $48 | $48 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $48 | $48 | $48 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $109 | $109 | $109 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $48 | $48 | $48 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $48 | $48 | $48 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $48 | $48 | $48 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $48 | $132 | $215 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $48 | $48 | $48 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $48 | $48 | $48 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $48 | $48 | $48 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $48 | $48 | $48 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $112 | $112 | $112 |
| Consultation office low complexity CPT 99243 • Office Visits | $48 | $82 | $115 |
| Consultation office high complexity CPT 99245 • Office Visits | $48 | $130 | $211 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $48 | $48 | $48 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $48 | $48 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $262 | $262 | $262 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $48 | $48 | $48 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $638 | $638 | $638 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $48 | $48 | $48 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $48 | $241 | $434 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $48 | $48 | $48 |
| Excision chalazion single CPT 67800 • Ophthalmology | $131 | $131 | $131 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,014 | $1,014 | $1,014 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $130 | $130 | $130 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $26 | $26 | $26 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $48 | $48 | $48 |