| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $148 | $148 | $148 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $129 | $129 | $129 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $64 | $207 | $350 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $164 | $271 | $379 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $58 | $58 | $58 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $30 | $30 | $30 |
| EMG needle each extremity complete CPT 95886 • Neurology | $86 | $94 | $102 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $110 | $110 | $110 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $77 | $77 | $77 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $70 | $70 | $70 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $90 | $90 | $90 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $133 | $133 | $133 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $50 | $60 | $72 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $36 | $69 | $95 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $36 | $112 | $155 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $36 | $106 | $152 |
| Office visit established patient minimal CPT 99211 • Office Visits | $10 | $23 | $36 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $26 | $40 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $36 | $46 | $55 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $36 | $64 | $87 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $36 | $110 | $168 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $65 | $69 | $73 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $120 | $120 | $121 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $168 | $208 | $248 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $36 | $39 | $43 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $60 | $85 | $111 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $85 | $114 | $144 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $75 | $75 | $76 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $103 | $103 |
| Consultation office low complexity CPT 99243 • Office Visits | $129 | $129 | $129 |
| Consultation office high complexity CPT 99245 • Office Visits | $196 | $196 | $196 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $605 | $682 | $758 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $55 | $55 | $55 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,203 | $1,203 | $1,203 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $245 | $303 | $361 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,083 | $1,083 | $1,083 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $581 | $581 | $581 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $296 | $361 | $426 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $663 | $854 | $1,046 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $355 | $572 | $789 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $171 | $175 | $180 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,192 | $1,387 | $1,582 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $515 | $588 | $661 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $357 | $718 | $1,080 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $566 | $566 | $566 |
| Excision chalazion single CPT 67800 • Ophthalmology | $121 | $127 | $133 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $559 | $559 | $559 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $159 | $180 | $201 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $75 | $75 | $75 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $97 | $122 | $147 |