| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $159 | $159 | $159 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $83 | $83 | $83 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $74 | $74 | $74 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $93 | $93 |
| Group psychotherapy CPT 90853 • Mental Health | $26 | $26 | $26 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $128 | $128 | $128 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $104 | $104 | $104 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $110 | $110 | $110 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $46 | $46 | $46 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $46 | $46 | $46 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $71 | $71 | $71 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $67 | $67 | $67 |
| EMG needle each extremity complete CPT 95886 • Neurology | $83 | $83 | $83 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $63 | $63 | $63 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $133 | $133 | $133 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $175 | $175 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $289 | $289 | $289 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $20 | $56 | $75 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $78 | $82 | $85 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $119 | $130 | $144 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $123 | $164 | $205 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $22 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $32 | $43 | $52 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $44 | $58 | $91 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $44 | $71 | $119 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $105 | $122 | $151 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $75 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $102 | $111 | $121 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $128 | $150 | $183 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $31 | $37 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $55 | $78 | $100 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $79 | $96 | $103 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $56 | $66 | $75 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $100 | $112 |
| Consultation office low complexity CPT 99243 • Office Visits | $105 | $105 | $105 |
| Consultation office high complexity CPT 99245 • Office Visits | $190 | $190 | $190 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $497 | $497 | $497 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $50 | $50 | $50 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $906 | $906 | $906 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $212 | $223 | $233 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $829 | $829 | $829 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $441 | $441 | $441 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $319 | $319 | $319 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $759 | $759 | $759 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $461 | $501 | $540 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $103 | $129 | $156 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,134 | $1,134 | $1,134 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $489 | $489 | $489 |