| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $3 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $143 | $143 | $143 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $89 | $147 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $119 | $126 | $134 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $343 | $355 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $53 | $270 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $103 | $107 | $111 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $77 | $133 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $33 | $43 | $52 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $63 | $104 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $55 | $88 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $163 | $169 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $91 | $188 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $43 | $66 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $105 | $112 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $124 | $149 | $164 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $131 | $178 | $216 |
| Office visit established patient minimal CPT 99211 • Office Visits | $8 | $24 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $49 | $55 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $66 | $88 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $30 | $95 | $125 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $157 | $169 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $96 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $116 | $139 | $170 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $128 | $188 | $248 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $39 | $77 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $90 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $105 | $144 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $84 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $113 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $65 | $100 |
| Consultation office high complexity CPT 99245 • Office Visits | $187 | $221 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $462 | $659 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $35 | $35 | $35 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,042 | $1,086 | $1,130 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $216 | $277 | $368 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $496 | $961 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $442 | $462 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $208 | $267 | $296 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $657 | $689 | $747 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $348 | $521 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $113 | $171 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $757 | $1,192 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $375 | $515 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $257 | $357 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $401 | $401 | $401 |
| Excision chalazion single CPT 67800 • Ophthalmology | $98 | $111 | $121 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $698 | $735 | $772 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $103 | $149 | $201 |