| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $5 | $6 | $7 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $89 | $684 | $2,723 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $123 | $310 | $896 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $106 | $285 | $896 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $144 | $369 | $479 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $163 | $420 | $546 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $79 | $115 | $168 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $92 | $156 | $236 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $84 | $125 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $37 | $92 | $134 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $41 | $97 | $171 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $117 | $159 | $203 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $153 | $210 | $270 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $102 | $253 | $409 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $57 | $87 | $107 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $80 | $119 | $156 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $105 | $178 | $238 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $144 | $225 | $300 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $22 | $29 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $29 | $53 | $62 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $47 | $88 | $126 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $71 | $123 | $155 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $102 | $149 | $210 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $74 | $147 | $218 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $112 | $156 | $202 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $163 | $227 | $299 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $37 | $48 | $57 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $61 | $99 | $154 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $87 | $143 | $222 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $70 | $103 | $156 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $106 | $133 | $157 |
| Consultation office low complexity CPT 99243 • Office Visits | $51 | $119 | $180 |
| Consultation office high complexity CPT 99245 • Office Visits | $178 | $310 | $412 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $517 | $1,461 | $4,824 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $220 | $896 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,092 | $4,986 | $18,765 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $189 | $751 | $2,723 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $180 | $2,752 | $10,502 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $422 | $2,706 | $10,502 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $374 | $1,014 | $2,723 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $641 | $2,918 | $10,502 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $437 | $2,739 | $10,502 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $89 | $319 | $896 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,379 | $5,314 | $18,765 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $681 | $1,201 | $2,723 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $295 | $1,109 | $2,723 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $425 | $2,331 | $10,502 |
| Excision chalazion single CPT 67800 • Ophthalmology | $95 | $275 | $896 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $493 | $2,750 | $10,502 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $108 | $294 | $896 |