| Psychotherapy 30 minutes CPT 90832 • Mental Health | $62 | $62 | $62 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $67 | $67 | $67 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $83 | $83 | $83 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $120 | $120 | $120 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $101 | $101 | $101 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $97 | $97 | $97 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $53 | $53 | $53 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $78 | $78 | $78 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $81 | $81 | $81 |
| Group psychotherapy CPT 90853 • Mental Health | $22 | $22 | $22 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $295 | $295 | $295 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $366 | $366 | $366 |
| EMG needle each extremity complete CPT 95886 • Neurology | $117 | $117 | $117 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $102 | $102 | $102 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $122 | $122 | $122 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $65 | $65 | $65 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $110 | $110 | $110 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $167 | $167 | $167 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $223 | $223 | $223 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $22 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $55 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $89 | $89 | $89 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $127 | $127 | $127 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $181 | $181 | $181 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $76 | $76 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $169 | $169 | $169 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $161 | $161 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $43 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $68 | $68 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $103 | $103 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $105 | $105 | $105 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $106 | $106 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $220 | $220 | $220 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $417 | $417 | $417 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $406 | $406 | $406 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $160 | $160 | $160 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $305 | $305 | $305 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $119 | $119 | $119 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $124 | $124 | $124 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $74 | $74 | $74 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $105 | $105 | $105 |
| Visual field examination CPT 92083 • Ophthalmology | $52 | $52 | $52 |
| Retinal imaging OCT posterior segment CPT 92134 • Ophthalmology | $23 | $23 | $23 |
| Ophthalmic biometry IOL power calculation CPT 92136 • Ophthalmology | $42 | $42 | $42 |
| Fundus photography CPT 92250 • Ophthalmology | $31 | $31 | $31 |
| Arthrocentesis aspiration major joint CPT 20610 • Orthopedics | $40 | $40 | $40 |
| Cervical spine fusion anterior approach CPT 22551 • Orthopedics | $2,182 | $2,182 | $2,182 |
| Total knee replacement CPT 27447 • Orthopedics | $1,651 | $1,651 | $1,651 |