| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $120 | $141 | $161 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $181 | $181 | $182 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $64 | $64 | $64 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $79 | $79 | $79 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $60 | $60 | $60 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $107 | $107 | $107 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $130 | $130 | $130 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $48 | $48 | $48 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $65 | $65 | $65 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $90 | $90 | $90 |
| Group psychotherapy CPT 90853 • Mental Health | $21 | $21 | $21 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $140 | $140 | $140 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $143 | $143 | $143 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $143 | $143 | $143 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $390 | $390 | $390 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $453 | $453 | $453 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $111 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $159 | $159 | $159 |
| EMG needle each extremity complete CPT 95886 • Neurology | $96 | $96 | $96 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $87 | $87 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $109 | $109 | $109 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $171 | $171 | $171 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $278 | $278 | $278 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $70 | $70 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $109 | $109 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $165 | $165 | $165 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $212 | $212 | $212 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $23 | $23 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $55 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $73 | $73 | $73 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $108 | $108 | $108 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $144 | $144 | $144 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $78 | $78 | $78 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $122 | $122 | $122 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $163 | $163 | $164 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $46 | $46 | $46 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $74 | $74 | $74 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $112 | $112 | $112 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $76 | $76 | $76 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $108 | $108 | $109 |
| Consultation office low complexity CPT 99243 • Office Visits | $98 | $114 | $129 |
| Consultation office high complexity CPT 99245 • Office Visits | $237 | $237 | $238 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $560 | $560 | $560 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $48 | $48 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,386 | $1,386 | $1,386 |