| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $115 | $115 | $115 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $73 | $73 | $73 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $111 | $111 | $111 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $111 | $111 | $111 |
| Group psychotherapy CPT 90853 • Mental Health | $36 | $36 | $36 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $115 | $115 | $115 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $111 | $111 | $111 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $137 | $137 | $137 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $61 | $61 | $61 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $171 | $171 | $171 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $50 | $50 | $50 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $55 | $55 | $55 |
| EMG needle each extremity complete CPT 95886 • Neurology | $91 | $91 | $91 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $53 | $53 | $53 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $145 | $145 | $145 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $106 | $106 | $106 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $188 | $188 | $188 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $8 | $8 | $8 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $8 | $8 | $8 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $17 | $17 | $17 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $188 | $188 | $188 |
| Office visit established patient minimal CPT 99211 • Office Visits | $1 | $1 | $1 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $49 | $49 | $49 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $37 | $37 | $37 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $12 | $66 | $119 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $17 | $17 | $17 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $51 | $51 | $51 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $146 | $146 | $146 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $161 | $161 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $70 | $70 | $70 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $37 | $37 | $37 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $105 | $105 | $105 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $11 | $11 | $11 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $54 | $54 | $54 |
| Consultation office low complexity CPT 99243 • Office Visits | $149 | $149 | $149 |
| Consultation office high complexity CPT 99245 • Office Visits | $268 | $268 | $268 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $276 | $276 | $276 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $27 | $27 | $27 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $811 | $811 | $811 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $68 | $68 | $68 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $597 | $597 | $597 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $63 | $63 | $63 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $210 | $210 | $210 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $107 | $107 | $107 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $33 | $33 | $33 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $22 | $22 | $22 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $805 | $805 | $805 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $670 | $670 | $670 |