| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $135 | $136 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $360 | $363 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $418 | $418 | $418 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $104 | $105 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $149 | $155 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $38 | $60 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $103 | $103 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $106 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $162 | $169 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $264 | $275 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $66 | $69 | $71 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $103 | $105 | $107 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $81 | $124 | $159 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $178 | $190 | $202 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $23 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $54 | $55 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $68 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $14 | $80 | $122 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $132 | $139 | $145 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $55 | $76 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $93 | $105 | $118 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $29 | $117 | $165 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $40 | $85 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $74 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $91 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $75 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $93 | $117 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $69 | $108 |
| Consultation office high complexity CPT 99245 • Office Visits | $32 | $146 | $204 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $545 | $545 | $545 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $45 | $45 | $45 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,130 | $1,130 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $666 | $1,302 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $544 | $605 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $30 | $30 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $30 | $30 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $30 | $30 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $323 | $616 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $218 | $405 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $541 | $541 | $541 |
| Excision chalazion single CPT 67800 • Ophthalmology | $98 | $111 | $123 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $966 | $966 | $966 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $142 | $142 | $142 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $42 | $42 | $42 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $93 | $93 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $86 | $86 | $86 |
| Eye exam established patient comprehensive CPT 92014 • Ophthalmology | $122 | $122 | $122 |
| Visual field examination CPT 92083 • Ophthalmology | $60 | $60 | $60 |