| Lumbar puncture diagnostic CPT 62270 • Neurology | $110 | $110 | $110 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $223 | $223 | $223 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $175 | $175 | $175 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $91 | $217 | $343 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $78 | $89 | $99 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $119 | $119 | $119 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $114 | $114 | $114 |
| EMG needle each extremity complete CPT 95886 • Neurology | $133 | $142 | $151 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $64 | $64 | $64 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $78 | $78 | $78 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $93 | $169 | $244 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $120 | $201 | $281 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $461 | $489 | $518 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $80 | $97 | $129 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $87 | $132 | $180 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $159 | $190 | $255 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $180 | $236 | $325 |
| Office visit established patient minimal CPT 99211 • Office Visits | $23 | $29 | $35 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $52 | $71 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $78 | $87 | $98 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $89 | $111 | $154 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $139 | $174 | $224 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $114 | $128 | $147 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $154 | $179 | $211 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $166 | $229 | $273 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $54 | $64 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $82 | $93 | $105 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $112 | $128 | $150 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $81 | $106 | $130 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $119 | $150 | $182 |
| Consultation office low complexity CPT 99243 • Office Visits | $149 | $149 | $149 |
| Consultation office high complexity CPT 99245 • Office Visits | $232 | $232 | $232 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $910 | $910 | $910 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $89 | $89 | $89 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,510 | $1,510 | $1,510 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $389 | $389 | $389 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,529 | $1,529 | $1,529 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $805 | $805 | $805 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $578 | $578 | $578 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,386 | $1,386 | $1,386 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $996 | $996 | $996 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $273 | $273 | $273 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $2,092 | $2,092 | $2,092 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $897 | $897 | $897 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $1,369 | $1,369 | $1,369 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $775 | $775 | $775 |
| Excision chalazion single CPT 67800 • Ophthalmology | $163 | $163 | $163 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $911 | $911 | $911 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $153 | $153 | $153 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $49 | $49 | $49 |