| Psychotherapy 60 minutes CPT 90837 • Mental Health | $120 | $120 | $120 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $111 | $111 | $111 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $168 | $168 | $168 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $87 | $87 | $87 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $87 | $87 | $87 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $107 | $107 | $107 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $88 | $88 | $88 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $224 | $224 | $224 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $143 | $143 | $143 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $161 | $161 | $161 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $137 | $137 | $137 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $32 | $32 | $32 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $103 | $103 | $103 |
| EMG needle each extremity complete CPT 95886 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $40 | $40 | $40 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $66 | $66 | $66 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $78 | $78 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $105 | $105 | $105 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $110 | $110 | $110 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $47 | $47 | $47 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $72 | $72 | $72 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $136 | $136 | $136 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $173 | $173 | $173 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $21 | $21 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $38 | $38 | $38 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $52 | $52 | $52 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $60 | $60 | $60 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $96 | $96 | $96 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $69 | $69 | $69 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $114 | $114 | $114 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $159 | $159 | $159 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $34 | $34 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $56 | $56 | $56 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $80 | $80 | $80 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $72 | $72 | $72 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $98 | $98 | $98 |
| Consultation office low complexity CPT 99243 • Office Visits | $94 | $94 | $94 |
| Consultation office high complexity CPT 99245 • Office Visits | $223 | $223 | $223 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $595 | $595 | $595 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $90 | $90 | $90 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,475 | $1,475 | $1,475 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $380 | $380 | $380 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,326 | $1,326 | $1,326 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $711 | $711 | $711 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $455 | $455 | $455 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,282 | $1,282 | $1,282 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $967 | $967 | $967 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $284 | $284 | $284 |