| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $152 | $152 | $152 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $84 | $84 | $84 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $78 | $78 | $78 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $102 | $102 | $102 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $100 | $100 | $100 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $164 | $164 | $164 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $130 | $130 | $130 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $159 | $159 | $159 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $76 | $76 | $76 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $115 | $115 | $115 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $116 | $116 | $116 |
| Group psychotherapy CPT 90853 • Mental Health | $39 | $39 | $39 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $189 | $189 | $189 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $208 | $208 | $208 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $146 | $146 | $146 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $63 | $63 | $63 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $143 | $143 | $143 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $45 | $45 | $45 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $30 | $30 |
| EMG needle each extremity complete CPT 95886 • Neurology | $46 | $46 | $46 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $56 | $56 | $56 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $67 | $67 | $67 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $92 | $92 | $92 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $105 | $105 | $105 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $77 | $77 | $77 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $115 | $115 | $115 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $162 | $162 | $162 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $174 | $174 | $174 |
| Office visit established patient minimal CPT 99211 • Office Visits | $25 | $25 | $25 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $41 | $41 | $41 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $66 | $66 | $66 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $99 | $99 | $99 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $121 | $121 | $121 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $81 | $81 | $81 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $130 | $130 | $130 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $192 | $192 | $192 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $39 | $39 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $67 | $67 | $67 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $95 | $95 | $95 |
| 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 | $96 | $96 | $96 |
| Consultation office low complexity CPT 99243 • Office Visits | $122 | $122 | $122 |
| Consultation office high complexity CPT 99245 • Office Visits | $227 | $227 | $227 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $635 | $635 | $635 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $194 | $194 | $194 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,192 | $1,192 | $1,192 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $411 | $411 | $411 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $992 | $992 | $992 |