| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $5 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $49 | $664 | $1,801 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $382 | $824 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $95 | $361 | $824 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $145 | $323 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $239 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $57 | $88 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $69 | $97 | $150 |
| EMG needle each extremity complete CPT 95886 • Neurology | $54 | $79 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $60 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $45 | $85 | $107 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $82 | $116 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $69 | $121 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $102 | $196 | $259 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $84 | $141 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $65 | $129 | $218 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $218 | $327 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $144 | $249 | $432 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $25 | $44 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $25 | $58 | $109 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $107 | $177 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $69 | $140 | $252 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $95 | $199 | $352 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $160 | $285 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $228 | $384 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $147 | $304 | $566 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $75 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $119 | $203 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $164 | $292 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $64 | $122 | $203 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $94 | $171 | $300 |
| Consultation office low complexity CPT 99243 • Office Visits | $51 | $192 | $341 |
| Consultation office high complexity CPT 99245 • Office Visits | $110 | $356 | $624 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $512 | $1,030 | $1,793 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $309 | $824 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $663 | $3,948 | $9,610 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $171 | $772 | $1,801 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $667 | $2,286 | $4,928 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $355 | $1,989 | $4,928 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $219 | $825 | $1,801 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $689 | $2,265 | $4,928 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $436 | $2,032 | $4,928 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $89 | $354 | $824 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $204 | $3,840 | $9,610 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $488 | $992 | $1,801 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $295 | $926 | $1,801 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $338 | $1,923 | $4,928 |
| Excision chalazion single CPT 67800 • Ophthalmology | $88 | $347 | $824 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $493 | $2,097 | $4,928 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $63 | $346 | $824 |