| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $107 | $107 | $107 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $61 | $61 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $93 | $93 | $93 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $114 | $114 | $114 |
| Group psychotherapy CPT 90853 • Mental Health | $27 | $27 | $27 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $1 | $1 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $12 | $12 | $12 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $14 | $14 | $14 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $18 | $18 | $18 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $252 | $252 | $252 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $214 | $214 | $214 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $38 | $38 | $38 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $46 | $46 | $46 |
| EMG needle each extremity complete CPT 95886 • Neurology | $19 | $19 | $19 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $105 | $105 | $105 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $69 | $69 | $69 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $204 | $204 | $204 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $197 | $197 | $197 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $4 | $4 | $4 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $9 | $9 | $9 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $85 | $85 | $85 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $160 | $160 | $160 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $1 | $1 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $33 | $33 | $33 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $5 | $5 | $5 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $55 | $55 | $55 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $49 | $49 | $49 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $39 | $39 | $39 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $11 | $11 | $11 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $16 | $16 | $16 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $16 | $16 | $16 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $44 | $44 | $44 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $13 | $13 | $13 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $29 | $29 | $29 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $64 | $64 | $64 |
| Consultation office low complexity CPT 99243 • Office Visits | $11 | $11 | $11 |
| Consultation office high complexity CPT 99245 • Office Visits | $170 | $170 | $170 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $502 | $502 | $502 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $38 | $38 | $38 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $817 | $817 | $817 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $276 | $276 | $276 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $546 | $546 | $546 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $87 | $87 | $87 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $38 | $38 | $38 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $981 | $981 | $981 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $705 | $705 | $705 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $32 | $32 | $32 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $34 | $34 | $34 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $309 | $309 | $309 |