| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $184 | $184 | $184 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $30 | $93 | $155 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $134 | $146 | $152 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $323 | $338 | $367 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $370 | $370 | $370 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $107 | $112 | $123 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $80 | $134 | $172 |
| EMG needle each extremity complete CPT 95886 • Neurology | $79 | $79 | $79 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $45 | $70 | $83 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $103 | $109 | $122 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $78 | $113 | $134 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $168 | $170 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $259 | $268 | $285 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $85 | $92 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $130 | $130 | $130 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $42 | $102 | $197 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $161 | $180 | $200 |
| Office visit established patient minimal CPT 99211 • Office Visits | $28 | $29 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $55 | $55 | $55 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $70 | $90 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $12 | $86 | $130 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $174 | $174 | $174 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $109 | $148 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $164 | $164 | $164 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $169 | $239 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $115 | $115 | $115 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $87 | $115 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $92 | $123 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $87 | $115 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $126 | $127 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $73 | $148 |
| Consultation office high complexity CPT 99245 • Office Visits | $213 | $250 | $269 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $512 | $512 | $512 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $81 | $81 | $81 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,267 | $1,403 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $326 | $326 | $326 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $780 | $1,155 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $670 | $763 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $30 | $192 | $353 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $42 | $492 | $942 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $30 | $394 | $758 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $30 | $89 | $120 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $30 | $535 | $1,545 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $420 | $615 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $30 | $279 | $404 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $710 | $710 | $710 |
| Excision chalazion single CPT 67800 • Ophthalmology | $20 | $85 | $151 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $902 | $921 | $941 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $112 | $144 | $175 |