| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $105 | $381 | $964 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $395 | $964 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $53 | $191 | $642 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $308 | $747 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $53 | $100 | $187 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $78 | $126 | $280 |
| EMG needle each extremity complete CPT 95886 • Neurology | $45 | $71 | $158 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $78 | $156 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $45 | $101 | $188 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $65 | $158 | $226 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $110 | $183 | $296 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $102 | $278 | $487 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $39 | $78 | $124 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $87 | $129 | $196 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $165 | $236 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $144 | $211 | $389 |
| Office visit established patient minimal CPT 99211 • Office Visits | $6 | $22 | $48 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $32 | $54 | $98 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $98 | $247 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $69 | $116 | $224 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $102 | $159 | $315 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $106 | $146 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $144 | $230 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $163 | $196 | $306 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $32 | $43 | $50 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $83 | $140 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $130 | $208 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $70 | $93 | $142 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $99 | $134 | $201 |
| Consultation office straightforward CPT 99241 • Office Visits | $61 | $61 | $61 |
| Consultation office low complexity CPT 99243 • Office Visits | $89 | $125 | $200 |
| Consultation office high complexity CPT 99245 • Office Visits | $110 | $209 | $296 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $515 | $1,704 | $4,058 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $31 | $311 | $964 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,015 | $5,277 | $15,251 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $189 | $1,175 | $3,348 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $239 | $3,354 | $9,194 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $437 | $3,084 | $9,194 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $219 | $1,234 | $3,348 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $689 | $3,330 | $9,194 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $504 | $3,197 | $9,194 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $79 | $361 | $964 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $227 | $5,210 | $15,251 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $398 | $1,402 | $3,348 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $295 | $1,350 | $3,348 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $425 | $3,151 | $9,194 |
| Excision chalazion single CPT 67800 • Ophthalmology | $95 | $378 | $964 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $493 | $3,133 | $9,194 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $101 | $388 | $964 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $38 | $72 | $136 |