| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $107 | $107 | $107 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $61 | $61 | $61 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $82 | $82 | $82 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $97 | $97 | $97 |
| Group psychotherapy CPT 90853 • Mental Health | $31 | $31 | $31 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $1 | $1 | $1 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $8 | $8 | $8 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $111 | $111 | $111 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $24 | $24 | $24 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $58 | $58 | $58 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $54 | $54 | $54 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $53 | $53 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $65 | $65 | $65 |
| EMG needle each extremity complete CPT 95886 • Neurology | $19 | $19 | $19 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $55 | $55 | $55 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $26 | $26 | $26 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $155 | $155 | $155 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $41 | $41 | $41 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $137 | $137 | $137 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $29 | $29 | $29 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $42 | $42 | $42 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $108 | $108 | $108 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $98 | $98 | $98 |
| Office visit established patient minimal CPT 99211 • Office Visits | $14 | $14 | $14 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $17 | $17 | $17 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $28 | $28 | $28 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $11 | $11 | $11 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $15 | $15 | $15 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $59 | $59 | $59 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $81 | $81 | $81 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $119 | $119 | $119 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $33 | $33 | $33 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $50 | $50 | $50 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $42 | $42 | $42 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $59 | $59 | $59 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $13 | $13 | $13 |
| Consultation office low complexity CPT 99243 • Office Visits | $86 | $86 | $86 |
| Consultation office high complexity CPT 99245 • Office Visits | $25 | $25 | $25 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $50 | $50 | $50 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $8 | $8 | $8 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $763 | $763 | $763 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $222 | $222 | $222 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $109 | $109 | $109 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $408 | $408 | $408 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $378 | $378 | $378 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $98 | $98 | $98 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $106 | $106 | $106 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $16 | $16 | $16 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $148 | $148 | $148 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $432 | $432 | $432 |