| Chemodenervation of muscle neck CPT 64616 • Neurology | $268 | $268 | $268 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $360 | $363 | $366 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $439 | $439 | $439 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $111 | $143 | $175 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $189 | $245 |
| EMG needle each extremity complete CPT 95886 • Neurology | $205 | $205 | $205 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $222 | $222 | $222 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $22 | $148 | $274 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $328 | $328 | $328 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $432 | $432 | $432 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $710 | $710 | $710 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $70 | $93 | $136 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $95 | $136 | $203 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $155 | $193 | $290 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $191 | $248 | $369 |
| Office visit established patient minimal CPT 99211 • Office Visits | $19 | $31 | $45 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $52 | $63 | $80 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $85 | $95 | $111 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $125 | $139 | $175 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $176 | $206 | $257 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $145 | $158 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $113 | $175 | $242 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $161 | $224 | $337 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $45 | $82 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $73 | $107 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $103 | $134 | $171 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $129 | $139 | $148 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $103 | $145 | $203 |
| Consultation office low complexity CPT 99243 • Office Visits | $30 | $152 | $256 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $364 | $472 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $689 | $1,094 | $1,499 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $133 | $133 | $133 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,130 | $1,670 | $2,210 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $197 | $389 | $736 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $2,383 | $2,383 | $2,383 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $777 | $1,072 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $284 | $538 | $792 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $30 | $863 | $1,880 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $411 | $949 | $1,487 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $109 | $633 | $1,158 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $3,209 | $3,209 | $3,209 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $1,339 | $1,339 | $1,339 |
| Retinal treatment extensive photocoagulation CPT 67228 • Ophthalmology | $327 | $898 | $1,882 |
| Strabismus surgery one horizontal muscle CPT 67311 • Ophthalmology | $1,066 | $1,066 | $1,066 |
| Excision chalazion single CPT 67800 • Ophthalmology | $123 | $226 | $328 |
| Blepharoptosis repair levator resection CPT 67901 • Ophthalmology | $772 | $967 | $1,163 |
| Lacrimal punctum closure by plug CPT 68761 • Ophthalmology | $104 | $232 | $360 |
| Eye exam new patient intermediate CPT 92002 • Ophthalmology | $150 | $150 | $150 |
| Eye exam new patient comprehensive CPT 92004 • Ophthalmology | $93 | $184 | $275 |
| Eye exam established patient intermediate CPT 92012 • Ophthalmology | $136 | $136 | $136 |