| Psychotherapy 60 minutes CPT 90837 • Mental Health | $150 | $150 | $150 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $131 | $131 | $131 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $157 | $157 | $157 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $75 | $75 | $75 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $121 | $121 | $121 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $125 | $125 | $125 |
| Group psychotherapy CPT 90853 • Mental Health | $30 | $30 | $30 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $7 | $7 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $113 | $113 | $113 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $173 | $173 | $173 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $187 | $187 | $187 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $475 | $475 | $475 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $473 | $473 | $473 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $93 | $93 | $93 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $102 | $102 | $102 |
| EMG needle each extremity complete CPT 95886 • Neurology | $116 | $116 | $116 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $55 | $55 | $55 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $82 | $82 | $82 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $183 | $183 | $183 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $244 | $244 | $244 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $144 | $144 | $144 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $93 | $93 | $93 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $94 | $94 | $94 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $204 | $204 | $204 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $206 | $206 | $206 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $11 | $11 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $31 | $31 | $31 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $91 | $91 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $133 | $133 | $133 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $179 | $179 | $179 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $123 | $123 | $123 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $166 | $166 | $166 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $246 | $246 | $246 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $48 | $48 | $48 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $87 | $87 | $87 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $126 | $126 | $126 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $88 | $88 | $88 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $131 | $131 | $131 |
| Consultation office low complexity CPT 99243 • Office Visits | $116 | $116 | $116 |
| Consultation office high complexity CPT 99245 • Office Visits | $230 | $230 | $230 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $789 | $789 | $789 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $76 | $76 | $76 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,701 | $1,701 | $1,701 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $400 | $400 | $400 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,409 | $1,409 | $1,409 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $929 | $929 | $929 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $341 | $341 | $341 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,142 | $1,142 | $1,142 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $921 | $921 | $921 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $146 | $146 | $146 |