| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $130 | $130 | $130 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $48 | $48 | $48 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $88 | $88 | $88 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $93 | $93 |
| Group psychotherapy CPT 90853 • Mental Health | $18 | $18 | $18 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $153 | $153 | $153 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $158 | $158 | $158 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $158 | $158 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $379 | $379 | $379 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $440 | $440 | $440 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $113 | $113 | $113 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $162 | $162 | $162 |
| EMG needle each extremity complete CPT 95886 • Neurology | $98 | $98 | $98 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $113 | $113 | $113 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $135 | $135 | $135 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $178 | $178 | $178 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $291 | $291 | $291 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $59 | $59 | $59 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $92 | $92 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $83 | $111 | $138 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $183 | $183 | $183 |
| Office visit established patient minimal CPT 99211 • Office Visits | $18 | $18 | $18 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $46 | $46 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $74 | $74 | $74 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $106 | $106 | $106 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $148 | $148 | $148 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $69 | $69 | $69 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $109 | $109 | $109 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $145 | $145 | $146 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $41 | $41 | $41 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $66 | $66 | $66 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $99 | $99 | $99 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $67 | $67 | $67 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $81 | $88 | $95 |
| Consultation office low complexity CPT 99243 • Office Visits | $104 | $113 | $123 |
| Consultation office high complexity CPT 99245 • Office Visits | $229 | $229 | $230 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $670 | $670 | $670 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $48 | $48 | $48 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,467 | $1,467 | $1,467 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,356 | $1,356 | $1,356 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $625 | $625 | $626 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $293 | $293 | $293 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $926 | $926 | $926 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $675 | $675 | $675 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $114 | $114 | $114 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $640 | $640 | $640 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $422 | $422 | $423 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $565 | $565 | $565 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $991 | $991 | $991 |