| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $60 | $60 | $60 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $88 | $88 | $88 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $91 | $91 | $91 |
| Group psychotherapy CPT 90853 • Mental Health | $17 | $17 | $17 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $56 | $56 | $56 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $94 | $94 | $94 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $94 | $94 | $94 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $316 | $316 | $316 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $282 | $282 | $282 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $46 | $46 | $46 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $60 | $60 | $60 |
| EMG needle each extremity complete CPT 95886 • Neurology | $62 | $62 | $62 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $37 | $37 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $43 | $43 | $43 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $72 | $72 | $72 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $98 | $98 | $98 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $66 | $66 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $93 | $93 | $93 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $90 | $90 | $90 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $142 | $142 | $142 |
| Office visit established patient minimal CPT 99211 • Office Visits | $13 | $13 | $13 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $22 | $22 | $22 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $50 | $50 | $50 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $54 | $54 | $54 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $97 | $97 | $97 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $70 | $70 | $70 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $94 | $94 | $94 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $139 | $139 | $139 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $34 | $34 | $34 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $49 | $49 | $49 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $71 | $71 | $71 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $63 | $63 | $63 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $73 | $73 | $73 |
| Consultation office low complexity CPT 99243 • Office Visits | $107 | $107 | $107 |
| Consultation office high complexity CPT 99245 • Office Visits | $152 | $152 | $152 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $535 | $535 | $535 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $32 | $32 | $32 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,026 | $1,026 | $1,026 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $214 | $214 | $214 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $664 | $664 | $664 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $437 | $437 | $437 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $260 | $260 | $260 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $650 | $650 | $650 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $438 | $438 | $438 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $70 | $70 | $70 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,039 | $1,039 | $1,039 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $449 | $449 | $449 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $211 | $211 | $211 |