| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $55 | $55 | $55 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $76 | $76 | $76 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $73 | $73 | $73 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $89 | $89 | $89 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $42 | $42 | $42 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $62 | $62 | $62 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $64 | $64 | $64 |
| Group psychotherapy CPT 90853 • Mental Health | $17 | $17 | $17 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $3 | $3 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $86 | $528 | $708 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $80 | $349 | $708 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $53 | $393 | $708 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $188 | $188 | $188 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $265 | $265 | $265 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $74 | $74 | $74 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $51 | $51 | $51 |
| EMG needle each extremity complete CPT 95886 • Neurology | $60 | $60 | $60 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $59 | $59 | $59 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $42 | $42 | $42 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $89 | $89 | $89 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $67 | $67 | $67 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $117 | $117 | $117 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $46 | $46 | $46 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $66 | $66 | $66 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $79 | $79 | $79 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $127 | $127 | $127 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $14 | $14 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $16 | $16 | $16 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $46 | $46 | $46 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $66 | $66 | $66 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $89 | $89 | $89 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $62 | $62 | $62 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $84 | $84 | $84 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $124 | $124 | $124 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $24 | $24 | $24 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $44 | $44 | $44 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $64 | $64 | $64 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $45 | $45 | $45 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $65 | $65 | $65 |
| Consultation office low complexity CPT 99243 • Office Visits | $76 | $76 | $76 |
| Consultation office high complexity CPT 99245 • Office Visits | $138 | $138 | $138 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $378 | $1,086 | $1,615 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $23 | $368 | $708 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $724 | $1,685 | $3,448 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $151 | $391 | $708 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $670 | $1,168 | $1,999 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $308 | $886 | $1,999 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $145 | $361 | $708 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $459 | $1,251 | $1,999 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $335 | $1,254 | $1,999 |