| Interactive complexity add-on CPT 90785 • Mental Health | $16 | $16 | $16 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $187 | $187 | $187 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $246 | $246 | $246 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $87 | $87 | $87 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $91 | $91 | $91 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $115 | $115 | $115 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $193 | $193 | $193 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $136 | $136 | $136 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $186 | $186 | $186 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $82 | $82 | $82 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $124 | $124 | $124 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $130 | $130 | $130 |
| Group psychotherapy CPT 90853 • Mental Health | $35 | $35 | $35 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $6 | $6 | $6 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $300 | $342 | $384 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $1 | $193 | $384 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $1 | $258 | $515 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $501 | $501 | $501 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $506 | $506 | $506 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $79 | $79 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $202 | $202 | $202 |
| EMG needle each extremity complete CPT 95886 • Neurology | $56 | $56 | $56 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $114 | $114 | $114 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $98 | $98 | $98 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $222 | $222 | $222 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $230 | $230 | $230 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $60 | $68 | $73 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $105 | $117 | $142 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $132 | $149 | $168 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $181 | $280 |
| Office visit established patient minimal CPT 99211 • Office Visits | $21 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $42 | $52 | $72 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $71 | $86 | $115 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $101 | $163 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $144 | $172 | $229 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $104 | $105 | $105 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $143 | $150 | $164 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $167 | $217 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $43 | $50 | $62 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $78 | $96 | $130 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $112 | $124 | $149 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $77 | $85 | $102 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $112 | $123 | $144 |
| Consultation office low complexity CPT 99243 • Office Visits | $111 | $122 | $143 |
| Consultation office high complexity CPT 99245 • Office Visits | $261 | $262 | $265 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $350 | $350 | $350 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $1 | $1 | $1 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1 | $1 | $1 |