| Psychotherapy 60 minutes CPT 90837 • Mental Health | $380 | $380 | $380 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $301 | $301 | $301 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $366 | $366 | $366 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $74 | $74 | $74 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $244 | $244 | $244 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $255 | $255 | $255 |
| Group psychotherapy CPT 90853 • Mental Health | $69 | $69 | $69 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $73 | $367 | $661 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $138 | $138 | $138 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $139 | $139 | $139 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $986 | $986 | $986 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $997 | $997 | $997 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $156 | $156 | $156 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $198 | $198 | $198 |
| EMG needle each extremity complete CPT 95886 • Neurology | $130 | $130 | $130 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $225 | $225 | $225 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $161 | $161 | $161 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $193 | $193 | $193 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $118 | $118 | $118 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $118 | $118 | $118 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $238 | $272 | $305 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $129 | $248 | $368 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $222 | $304 | $436 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $237 | $386 | $593 |
| Office visit established patient minimal CPT 99211 • Office Visits | $12 | $20 | $29 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $62 | $124 | $187 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $103 | $201 | $300 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $152 | $338 | $438 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $204 | $400 | $595 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $270 | $341 | $412 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $426 | $492 | $558 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $565 | $734 | $819 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $160 | $161 | $161 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $257 | $275 | $293 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $387 | $403 | $420 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $265 | $279 | $293 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $373 | $413 | $433 |
| Consultation office low complexity CPT 99243 • Office Visits | $370 | $459 | $503 |
| Consultation office high complexity CPT 99245 • Office Visits | $690 | $690 | $690 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $622 | $622 | $622 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $38 | $38 | $38 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,340 | $1,340 | $1,340 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $233 | $233 | $233 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,083 | $1,083 | $1,083 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $503 | $503 | $503 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $297 | $297 | $297 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $736 | $736 | $736 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $537 | $537 | $537 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $112 | $112 | $112 |