| Psychotherapy 45 minutes CPT 90834 • Mental Health | $125 | $125 | $125 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $158 | $158 | $158 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $161 | $161 | $161 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $119 | $119 | $119 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $143 | $143 | $143 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $81 | $81 | $81 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $132 | $132 | $132 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $114 | $114 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $66 | $66 | $66 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $48 | $48 | $48 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $45 | $45 | $45 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $156 | $156 | $156 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $403 | $403 | $403 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $401 | $401 | $401 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $94 | $116 | $138 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $134 | $134 | $134 |
| EMG needle each extremity complete CPT 95886 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $110 | $110 | $110 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $97 | $120 | $143 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $77 | $77 | $77 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $224 | $224 | $224 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $344 | $344 | $344 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $87 | $87 | $87 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $48 | $48 | $48 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $92 | $110 | $129 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $162 | $186 | $209 |
| 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 | $95 | $95 | $95 |
| 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 | $131 | $214 |
| 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 | $96 | $114 | $132 |
| Consultation office low complexity CPT 99243 • Office Visits | $108 | $118 | $129 |
| Consultation office high complexity CPT 99245 • Office Visits | $45 | $47 | $48 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $48 | $48 | $48 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $48 | $48 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $48 | $48 | $48 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $374 | $399 | $423 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $48 | $48 | $48 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $48 | $48 | $48 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $25 | $37 | $48 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $48 | $48 | $48 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $45 | $45 | $45 |