| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $170 | $170 | $170 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $196 | $196 | $196 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $69 | $69 | $69 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $65 | $65 | $65 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $91 | $91 | $91 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $100 | $100 | $100 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $134 | $134 | $134 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $133 | $133 | $133 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $157 | $157 | $157 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $76 | $76 | $76 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $98 | $98 | $98 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $102 | $102 |
| Group psychotherapy CPT 90853 • Mental Health | $24 | $24 | $24 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $5 | $5 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $214 | $214 | $214 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $174 | $174 | $174 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $155 | $155 | $155 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $55 | $55 | $55 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $396 | $396 | $396 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $70 | $70 | $70 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $52 | $52 | $52 |
| EMG needle each extremity complete CPT 95886 • Neurology | $44 | $44 | $44 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $38 | $38 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $58 | $58 | $58 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $105 | $105 | $105 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $26 | $42 | $59 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $30 | $60 | $90 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $30 | $90 | $150 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $196 | $196 | $196 |
| Office visit established patient minimal CPT 99211 • Office Visits | $27 | $27 | $27 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $30 | $30 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $56 | $82 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $60 | $91 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $166 | $166 | $166 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $118 | $118 | $118 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $162 | $162 | $162 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $239 | $239 | $239 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $49 | $49 | $49 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $88 | $88 | $88 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $126 | $126 | $126 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $89 | $89 | $89 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $129 | $129 | $129 |
| Consultation office low complexity CPT 99243 • Office Visits | $166 | $166 | $166 |
| Consultation office high complexity CPT 99245 • Office Visits | $302 | $302 | $302 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $757 | $757 | $757 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $64 | $64 | $64 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,431 | $1,431 | $1,431 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $408 | $408 | $408 |