| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $54 | $113 | $172 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $146 | $146 | $146 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $144 | $151 | $158 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $351 | $351 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $50 | $287 | $524 |
| EMG needle each extremity complete CPT 95886 • Neurology | $47 | $77 | $107 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $202 | $202 | $202 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $125 | $125 | $125 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $83 | $116 | $150 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $93 | $145 | $196 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $195 | $256 | $317 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $83 | $84 | $86 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $100 | $110 | $119 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $151 | $167 | $184 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $170 | $200 | $230 |
| Office visit established patient minimal CPT 99211 • Office Visits | $28 | $38 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $60 | $68 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $84 | $95 | $106 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $120 | $140 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $162 | $165 | $167 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $101 | $113 | $124 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $154 | $155 | $155 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $214 | $222 | $229 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $53 | $62 | $72 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $68 | $75 | $82 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $118 | $121 | $124 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $82 | $91 | $99 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $121 | $129 | $136 |
| Consultation office low complexity CPT 99243 • Office Visits | $117 | $117 | $117 |
| Consultation office high complexity CPT 99245 • Office Visits | $216 | $216 | $216 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $665 | $665 | $665 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $143 | $143 | $143 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,019 | $1,019 | $1,019 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $257 | $257 | $257 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,283 | $2,283 | $2,283 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $316 | $316 | $316 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $650 | $650 | $650 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $478 | $478 | $478 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $119 | $119 | $119 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,018 | $1,018 | $1,018 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $542 | $542 | $542 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $356 | $356 | $356 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $1,248 | $1,248 | $1,248 |
| Excision chalazion single CPT 67800 • Ophthalmology | $137 | $137 | $137 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $1,565 | $1,565 | $1,565 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $152 | $152 | $152 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $90 | $90 | $90 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $128 | $143 | $158 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $96 | $96 | $96 |