| Psychotherapy 60 minutes CPT 90837 • Mental Health | $389 | $389 | $389 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $339 | $339 | $339 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $409 | $409 | $409 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $195 | $195 | $195 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $315 | $315 | $315 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $327 | $327 | $327 |
| Group psychotherapy CPT 90853 • Mental Health | $79 | $79 | $79 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $16 | $16 | $16 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $365 | $365 | $365 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $275 | $275 | $275 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $264 | $264 | $264 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $871 | $871 | $871 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $1,026 | $1,026 | $1,026 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $202 | $202 | $202 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $515 | $515 | $515 |
| EMG needle each extremity complete CPT 95886 • Neurology | $128 | $128 | $128 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $125 | $125 | $125 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $207 | $207 | $207 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $444 | $444 | $444 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $256 | $256 | $256 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $579 | $579 | $579 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $88 | $136 | $184 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $185 | $229 | $273 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $283 | $330 | $378 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $357 | $391 | $424 |
| Office visit established patient minimal CPT 99211 • Office Visits | $34 | $34 | $34 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $74 | $100 | $127 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $89 | $147 | $205 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $184 | $209 | $233 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $194 | $301 | $408 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $178 | $178 | $178 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $240 | $240 | $240 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $354 | $354 | $354 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $69 | $91 | $113 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $126 | $126 | $126 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $183 | $183 | $183 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $126 | $126 | $126 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $187 | $187 | $187 |
| Consultation office low complexity CPT 99243 • Office Visits | $211 | $211 | $211 |
| Consultation office high complexity CPT 99245 • Office Visits | $386 | $386 | $386 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $1,506 | $1,506 | $1,506 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $133 | $133 | $133 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,320 | $2,320 | $2,320 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $408 | $408 | $408 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,131 | $2,131 | $2,131 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $1,251 | $1,251 | $1,251 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $460 | $460 | $460 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,555 | $1,555 | $1,555 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $1,249 | $1,249 | $1,249 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $197 | $197 | $197 |